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Full text of "Report of the Metropolitan Commissioners in Lunacy to the Lord Chancellor : presented to both houses of Parliament by command of Her Majesty"

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K REPORT 



METROPOLITAN COMMISSIONERS 
IN LUNACY, 



LORD CHANCELLOR. 



PRESENTED TO BOTH HOUSES OF PARLIAMENT BY COMMAND 
OF HER MAJESTY. 



LONDON: 

^ BRADBURY AND EVANS, PRINTERS, WHITEFRIARS. 

1844. 



f LONDON : 



BRADBIRY AND EV^ANS, PRINTERS, WHITEFRIARS. 



COMMISSIONERS.-1843 86 IS'l^. 



LORD SEYMOUR. 

LORD ASHLEY, 

RIGHT HON. R. VERNON SMITH. 

ROBERT GORDON, Esq. 

COLONEL WILLIAM HENRY SYKES. 

JAMES MILNES GASKELL, Esq. 

JOHN BARNEBY, Esq. 

FRANCIS BARLOW, Esq. 

JAMES ROBERT GOWEN, Esq. 

DOCTOR THOMAS TURNER. 

DOCTOR JOHN BRIGHT. 

DOCTOR HENRY HERBERT SOUTHEY. 

DOCTOR JOHN ROBERT HUME. 

DOCTOR THOMAS WATERFIELD. 

DOCTOR FRANCIS BISSET HAWKINS. 

DOCTOR JAMES COWLES PRICHARD. 

JAMES WILLIAM MYLNE, Esq. 

BRYAN WALLER PROCTER, Esq. 

JOHN HANCOCK HALL, Esq. 

R. W. SKEFFINGTON LUTWIDGE, Esq. 



EDWARD DU BOIS, Clerk and Treasurer. 

Office, 12, Abingdon Street^ 
Westminster. 



TABLE OF CONTENTS. 





PAGE 


Preliminary Observations . . , • . 


1 


The different Classes of Lunatic Asylums, their ConstxTiction, Con- 




dition, Management, and Visitation 


9 


County Asylums ...... 


10 


County Asylums partly supported by Contributions . 


30 


Naval and Military Hospitals .... 


31 


Public Hospitals supported wholly or partly by Voluntary Contri 




butions ....... 


32 


Licensed Houses . . . 


34 


Abuses and Defects ...... 


46 


Condition of Paupers on Admission 


79 


Fonns of Disease ...... 


102 


Medical Treatment . . . . . 


113 


Diet 


118 


Classification of Lunatics ..... 


121 


Occupation, Amusements, and Exercise 


128 


Restraint ....... 


137 


Religious Services ...... 


. 159 


On the Admission and Liberation of Patients 


163 


Statistics of Insanity ...... 


177 


Criminal Lunatics ...... 


195 


Wales ........ 


. 199 


Suggestions for the Amendment of the Law 


. 204 


Appendix A. . 


. 209 


„ B 


. 214 


„ C. . 


. 223 


„ D. - . . . 


. 236 


„ E 


. 244 


„ F, sheet inserted at . 


. 274 


„ G 


. 274 



TO THE 



LORD HIGH CHANCELLOR, 

OF ENGLAND. 



TITE, the Metropolitan Commissioners in Lunacy, beg 

to submit to your Lordship the following Report, 

relating to the several matters entrusted to our care. 

As our duties have been materially increased, by 

the provisions of the Act 5 & 6 Vic. c. 87, which have 

enabled us to inspect the condition of the various public 

and private Asylums throughout England and Wales, 

beyond as well as within the limits of the Metropolitan 

district, we think it right to report to your Lordship the 

result of our experience, in a more minute and specific 

way than we have heretofore been accustomed to do. 

Your Lordship is aware that the legislative provi- Legislative pio- 
p 1 J.- J. T i- A 1 • visions now m 

sions now in force relative to Lunatic Asylums m force. 

England, are for the most part comprised in the public 

Acts of 9 Geo. IV. c. 40 ; 2 & 3 Will. IV. c. 107 ; 

and 5 & 6 Vic. c. 87. 

The Act 9 Geo. IV. c. 40, relates mainly to the for- 9 Geo. IV. c 

mation and management of County Asylums ; and several 

other Statutes have been subsequently passed, by means 

of which various Lunatic Establishments, not originally 

B 



IV. c. 107. 



erected for County purposes, have been brought within 
the regulations of that Act. There are, however, several 
other Asylums of a mixed character, supported wholly 
or partially by charitable contributions, to which the 
Act last referred to does not apply. 

2 & 3 Will. The Act 2 & 3 Will. IV. c. 107, (enlarged and 

continued by later Acts) relates to all licensed Lunatic 
Asylums throughout England and Wales ; and directs 
certain of the Metropolitan Commissioners (amongst 
other things,) to visit the several licensed Houses 
within the limits of the County of Middlesex^ and of 
certain specified portions of Surrey and Kent, (which 
limits are now known as the Metropolitan dis- 
trict,) four times in each year, and to report to your 
Lordship as to their condition. This Act also directs, 
that three Justices, together with a Medical Attend- 
ant, shall be appointed at the General Quarter Ses- 
sions to visit all Houses Licensed for Lunatics, in 
the various counties of England, three times in every 
year, 

5 & 6 Vic. c. The Act 5 & 6 Vic. c. 87, relates to all Lunatic 

Asylums in England and Wales, whether private or 
public, except to the Hospital of Bethlem ; and by this 
Act certain of the Metropolitan Commissioners are di- 
rected, twice a year, to visit and report on the Licensed 
Asylums in the provinces, and once a year to visit and 
report on the County and other Asylums regulated 
under the Act of 9 Geo. IV. c. 40 ; and your Lordship 
is also empowered to direct us to visit the Royal Mili- 
tary and Naval Hospitals, and all other public Asylums 
for the reception of insane persons in England and 
Wales, except the Hospital of Bethlem. This power 
your Lordship has thought proper to exercise, in order 
that we might have a more complete opportunity of 
ascertaining the present state of Lunacy in this Coun- 
try, and of judging of the sufficiency of the existing 
laws relating thereto. ^ 



87. 



We have tlioiight it right to mention the general 
purport of these Acts, as it will be necessary to advert to 
some of them in subsequent parts of this Eeport. 

The total number of Lunatic Asylums, public and Number of 
private, which we have thus been authorized to visit, ^^ ""'^' 
amounts to 166; viz.: — 

17 County Asylums or Asylums brought within the 
scope of 9 Geo. IV. c. 40., viz. : 
12 County Asylums. 
5 County and Subscription Asylums. 
1 1 Asylums of a mixed character, maintained partly 
by subscription and partly by income arising 
from charitable foundations. 
2 Military and Naval Hospitals. 
99 Houses licensed by the Justices in Session ; viz. : 
59 which receive private patients only. 
40 which receive paupers as well as private 
patients; of which, 4 are parts of 
Workhouses. 
37 Houses licensed by the Metropolitan Commis- 
sioners ; viz. : 

33 which receive private patients only. 
4 which receive paupers as well as 
private patients. 

A list of Asylums, with the weekly charges for Appendix (A.) 
pauper patients, and the number of patients in each 
Asylum on the 1st January, 1844, will be found in 
Appendix (A). 

In addition to the Asylums above enumerate^, 4 Additional 

XX 1 1 T iiiiTi- ' CI • Houses license 

Houses have been licensed by the Justices m Session, ^^^^^ j^^^ j 
and 3 by the Metropolitan Commissioners, since the 1844. 
1st January, 1844. 

The Asylums above mentioned, with the addition of 
the Hospital of Bethlem, comprehend all the Asylums 
for Lunatics in England and Wales, which are at 
present expressly recognised by law. 
b2 



Division into 
districts for 
visitation. 



Inquiries made 
bv Commis- 



Befoi'e entering into a more minute examination of 
the subject, which it is our duty to bring before your 
Lordship, we beg to state that in pursuance of the 
7th section of the Act 5 & 6 Vict. c. 87, a Board 
of the Metropolitan Commissioners was assembled, 
at which the whole of England and "Wales was 
divided into four districts ; regard being had to the 
number of public and private Asylums necessary to 
be visited, and also to the numbers of patients confined 
therein ; and that each of these districts was again sub-^ 
divided into two parts, for the purpose of more 
conveniently distributing the visitations amongst the 
Legal and Medical Commissioners. 

Throughout the course of the visitations, made in 
pursuance of this arrangement, we have endeavoured to 
carry into full effect the spirit as well as the letter of the 
Acts of Parliament : and with this view, we have ex- 
tended our inquiries to many subjects beyond those 
which are specifically mentioned in those Acts. Our 
experience within the Metropolitan district has suggested 
some of these inquiries ; and we have also obtained in- 
formation from intelligent persons acquainted with the 
provincial Asylums, as to their general character and 
management. It has been our endeavour to ascertain 
the treatment to which the lunatic (particularly the pau- 
per lunatic) has been subjected from the commencement 
of his disease, previously to his reception in an Asylum, 
to his final discharge. For this purpose, we have 
visited various Workhouses and other places ; have 
observed the condition of the inmates ; have learned 
how and upon what principle the insane poor have 
been removed thence to Lunatic Asylums ; to what 
extent their comfort has been afterwards secured ; 
how often and with what care they have been visited ; 
what benefit they have derived from medical treatment ; 
and what may be the impediments to, or facilities for 
their liberation when they are restored to health. The 



excellencies or defects in certain points which we have 
found existing in some institutions, have instructed us 
to direct our attention to the same points in others. 

We have examined, minutely, into the manage- 
ment of various Asylums, their resources, their secu- 
rity, superintendence, and general arrangements, includ- 
ing their domestic economy, and also their external 
government and supervision : it being quite obvious 
that many abuses and defects might exist undiscovered in 
these establishments, if the mere condition and appear- 
ance of each place, at the period of our visit, were admit- 
ted as a su.fficient criterion of its condition, at all other 
times and seasons. We have deemed it right to inspect 
the clothing, bedding, and food, of the patients, and 
to inquire into every circumstance connected with their 
subsistence, comfort, and general management; more 
especially in all establishments for paupers. We have 
perused the Magistrates' reports, and have inquired 
into the frequency of their visits, ^he nature and extent 
uf the inquiries instituted by them, and the general 
result of their investigations. We have examined all the 
registers, with a view to ascertain, as much as possible, 
the amount of intelligence and care exercised in reference 
to Lunatic Patients, by the visiting Medical Officers ; 
and we have also (as directed by the Acts) given our 
attention to the questions of religious exercises, classifi- 
cation, and restraint. 

In addition to the foregoing subjects, we have, in 
some instances, thought it advisable to make inquiries 
as to the origin of the Asylum, and the funds out of 
which it is supported ; as to the experience of the 
Medical Attendant, his duties, and the remuneration 
given to him ; as to the particular duties of the Matron, 
and various attendants, and their wages ; as to the oppor- 
tunities afforded of learning the previous history of 
Patients, the mode of ascertaining their convalescence, 
and of obtaining their discharge; as to the remedies 



6 



General state- 
ment of condi- 
tion of Asy- 
lums. 



Asylums for 
lunatic poor, 



filled with in- 
curable patients. 



employed, especially in the cases of dirty and helpless 
patients ; as to the number of cures, deaths, relapses, 
and other statistical matters, which will be hereinafter 
specially referred to ; as to the Dietary, and the means 
of adapting it to the exigencies of the disease ; and as 
to various other points, involving the general comforts 
of Lunatic Patients. 

The Asylums thus brought before our view, ex- 
hibit instances of almost every degree of merit and 
defect. Some are constructed on an extensive scale, 
and combine most of the advantages and comforts of a 
wealthy establishment. Others are mean, poor, confined 
within narrow bounds, and almost wholly without 
comforts or resources of any kind. Some are situate 
in open and healthy places, in the midst of large airing 
grounds, and cheerful prospects. Others are in the centre 
of towns or populous suburbs, without good air, and 
without space sufficient for daily exercise. In some 
places, books and amusements are furnished abundantly 
for the benefit of Patients, and various means of occu- 
pation, adapted to their capacities and previous habits, 
are provided. In others, the Lunatic is left to pass his 
time listless and unoccupied, or occupied only with the 
delusions that disturb him, and which thus, being 
diverted by no amusement or employment, in the course 
of time become strengthened, and not to be removed. 

The Asylums in which the lunatic poor are received, 
have however been the subject of our most especial 
enquiries. These places (even such of them as are 
upon the most extended scale) are, we regret to say, 
filled with incurable patients, and are thus rendered 
incapable of receiving those whose malady might still 
admit of cure. It has been the practice, in numerous 
instances, to detain the insane pauper at the work- 
liouse or elsewhere, until he becomes dangerous or 
unmanageable ; and then, when his disease is beyond all 
medical relief, to send him to a Lunatic Asylum where 



he may remain during the rest of his life, a pensioner 
on the public. This practice, which has been carried on 
^r the sake of saving, in the first instance, to each pa- 
rish some small expense, has confirmed the malady of 
many poor persons, has destroyed the comfort of families, 
has ultimately imposed a heavy burthen upon parishes 
and counties, and has, in a great measure, nullified the 
utility of public Lunatic Asylums, by converting them 
into a permanent refuge for the insane, instead of hospitals 
for their relief or cure. For years past, we have endea- 
voured, within the Metropolitan District, to diminish this 
evil practice; but it still prevails; and we doubt whether 
it will be altogether suppressed, unless some plan be 
adopted and enforced, for removing, from time to time, 
each Lunatic as he becomes incurable from the Asylum 
to which he has been sent, and supplying his place by 
another whose case, from the recent nature of the attack, 
may still admit of cure; and unless, also, there be a 
strict and frequent supervision, not only of Asylums, 
but of all Workhouses, and other places in which the 
lunatic poor are detained. We beg to refer your Lord- 
ship to the subsequent pages of this Report, for more 
detailed information on this important point. 

The number of insane persons ascertained to exist in Number of in 
England and Wales, exceeds 20,000 ; and there is every England* and 
reason to believe that this is considerably below the ^^^^s. 
actual amount. They belong to every station in society; 
but by far the largest proportion of them (exceeding in 
fact two-thirds of the whole), are objects of charity, and Two thirds 

. . , . , , ,. mi maintained at 

are mamtamed entirely at the public expense. Ihese the public 
unhappy persons are, for the most part, necessarily ^^pense. 
removed from their homes, and consigned to the protec- 
tion of a Lunatic Asylum, by their relations and friends. 
We have, therefore, entered upon the discharge of our 
duty, with a strong sense of the claims of the Insane 
upon our vigilance and care. We are desirous, at the 
same time, to do justice to those to whose charge the 



8 



Assistance ren- 
dered by Medi- 
( ill Officers and 
Superintendents 
of Asylums to 
Commissioners. 



Subject divided 
into heads. 



Insane are committed ; and, with this view, we beg 
leave to bring before your Lordship's notice one class 
of persons, who, in the course of our labours, have 
rendered us the most cordial and valuable assist- 
ance, — we refer to the resident Medical Officers and 
Superintendents of the great public Institutions and 
well-conducted private Asylums throughout the king- 
dom. "We entertain a high opinion of the ability and 
zeal with which these gentlemen devote themselves to 
the performance of their arduous duties; and we feel 
bound to state, that, although on many occasions we 
have been compelled to impose upon them much 
trouble, they have affi^rded us their assistance with the 
utmost readiness. 

After these preliminary observations, we proceed to 
call your Lordship's attention to the present condition 
of Lunacy in England ; and for the greater convenience 
of shewing the result of our investigations, we shall 
divide the subject into the following heads, viz. : 

I. The different Classes of Lunatic Asylums, their 

Construction, Condition, Management, and 
Visitation. 

II. Condition of Paupers, on Admission. 

III. Forms of Disease, Medical Treatment, Diet, 

and Classification. 

IV. Occupations and Amusements. 
V. Restraint. 

VI. Religious Services. 

VII. The Admission and Liberation of Patients. 
VIII. Statistics of Insanity. 
IX. Criminal Lunatics. 
X. Wales. 



THE DIFFERENT CLASSES OF LUNATIC ASYLUMS, 
THEIR CONSTRUCTION, CONDITION, MANAGE- 
MENT, AND VISITATION. 



The distinctions which exist between the various Asylums df- 
Lunatic Asylums in England, and the nature and extent classes. 
of their accommodations, will be better understood, if 
the Asylnms are divided into classes, and a brief enu- 
meration is given of the principal points in which they 
differ from each other. They may be divided into five 
classes : — 

First. — Coimty Asylums, which have been established County Asy- 
under the the Acts of 48 Geo. III. c. 96, and 9 Geo. "™^' 
TV. c. 40, and have been erected by Counties, and paid 
for wholly out of County rates, for the reception 
of Paupers ; but in some of which private Patients 
have nevertheless been received. In this class, are 
included the Asylums for the Counties of Bedford, 
Chester, Dorset, Kent, Lancaster, Middlesex, Norfolk, 
Suffolk, Surrey, and for the West Riding of the County 
of York : in this class, also, may be included the Asylum 
at Haverfordwest, St. Peter s Hospital, Bristol, and 
the Workhouse at Hull, which have been declared 
County Asylums under special Acts of Parliament. 

Secondly. — County Asylums united with Subscrip- County Asy- 
tion Asylums, which have been established under the 1"™^ united 

•^ with Subscnp- 

last-mentioned Acts, and have been erected by Counties tion Asylums, 
and subscribers, and paid for partly out of County 
rates, and partly by private subscription. In this class 
are included the Asylums for the Counties of Cornwall, 
Gloucester, Leicester, Nottingham, and Stafford. 



10 



Military and 
Naval Hospitals 



Public Hospi- 
tals, &c. sup- 
ported wholly 
or in part by 
voluntary con- 
tributions. 



Licensed 
Houses ; 



including parts 
of certain 
Workhouses. 



Bethlem Hos- 
pital not 
included above. 
Workhouses 
not licensed, 
containing 
Lunatic wards. 



Thirdly. — The Lunatic wards of the Royal Military 
and Naval Hospitals, supported by, and under the 
control of the Government. 

Fourthly. — Public Hospitals, and parts of Hospitals 
or other Charitable Institutions, supported wholly or 
partly by voluntary contributions. Of this class are the 
Lunatic Asylums at Exeter, Lincoln, and Northampton ; 
the "Wanieford, (formerly called the Radcliffe,) at Oxford, 
the Retreat at York, the York Asylum, St. Luke's 
Hospital, the Bethel Hospital at Norwich, the Lunatic 
ward of Guy's Hospital, the Hospital at Manchester, 
and the Liverpool Asylum. 

Lastly. — Licensed Houses, which receive Private 
Patients only. Private and Pauper Patients jointly, or 
Pauper Patients only. This class includes the licensed 
parts of the following Workhouses, viz., the House of 
Industry for the Isle of "Wight at Carisbrooke, the 
Workhouse at Devonport, the Houses of Industry at 
Kingsland near Shrewsbury, and at Morda near 
Oswestry. 

The Royal Hospital of Bethlem is not included in 
the above enumeration. 

Besides the several Asylums already described, there 
are numerous Workhouses belonging to Parishes and 
Unions, which are not licensed for the reception of the 
Insane, but which, nevertheless, contain wards exclu- 
sively appropriated to Lunatics, and receive large num- 
bers of Insane persons, dangerous as well as harmless ; 
such as the Workhouses at Birmingham, Manchester, 
Sheffield, Bath, Leicester, Redruth, in Cornwall, the 
Infirmary Bethel at Norwich, and others. 



County Asy- 
lums erected 
under 48 Geo. 
in. c. 96, and 
9 Geo. IV. 
c. 40. 



1. County Asylums. 

The existing County Asylums have been erected 
under the provisions of the Acts of 48 Geo. III. c. 96, 
and 9 Geo. IV. c. 40. The former of these Acts directs 



11 

the Visiting Justices to fix upon an airy and healthy 
situation, with a good supply of water, affording 
a probability of the vicinity of medical assistance, 
and to provide separate wards, day rooms, and airing 
grounds for males and females, and for the convales- 
cents and incurables, and dry and airy cells. The Act 
of 48 Geo. III., is repealed by the Act of 9 Geo. IV. 
c. 40, except as to matters done before the passing of 
the latter Act. This latter Act omits the directions as 
to the site, and plans of Asylums ; but gives special 
directions as to the contracts for the purchase of land, 
and for the erection of County Asylums. 

We made inquiries at the County Lunatic Asylums Contracts for 
as to the mode in which contracts for the purchase of F"''?^'^"^, 

, , ^ land tor build- 

land tor the erection of buildings have been entered '"gs. 

into, and carried into execution : but these contracts, 
and all orders relating thereto, being directed to be kept 
amongst the records of the different counties, we found 
that scarcely any information upon the subject could 
be obtained at the asylums. We have, however, pro- 
cured the most accurate statements we could obtain of 
the cost of the land, and the buildings of many of the 
Asylums, and these, together with other particulars, 
will be found in Appendix(B). Your Lordship will per- Appendix (B). 
ceive from the perusal of these statements, that the 
County Asylums which have hitherto been erected 
have caused a heavy expense to the rate-payers, an 
expense which we fear has prevented the increase of 
these most useful establishments*. Although we have 

* The Magistrates of tte North Riding of Yorkshire are about to 
erect a County Lunatic Asylum for their Paupers. There are several 
Corporate and Borough towns in the North Riding which are believed 
to be desirous of uniting with the County Magistrates in the erecting 
of their Asylum, but it has been considered that the Acts of 9 Geo. 
IV. c. 40, and 5 & 6 Will. IV. c. 76, do not authorize such unions. 
Our attention has been drawn to this subject by the Chairman of the 
Quarter Sessions for th^ North Riding of Yorkshire ; and we think 
that it is desirable that the Act of 9 Geo. IV. c. 40, should be 
amended in this respect. 



12 



Comparative 
cost of Union 
Woikhouses 
and Asylums. 



Increase of ex- 
pense by making 
building fire- 
proof. 



Use of single 
cells. 



Doimitorics. 



no wish to advocate the erection of unsightly buildings 
we think that no unnecessary cost should be incurred 
for architectural decoration ; especially as these Asylums 
are erected for persons who, when in health, are accus- 
tomed to dwell in cottages. 

The best Union Workhouses have in general cost 
not more than 40^., whilst Pauper Lunatic Asylums, 
have, in some cases, cost upwards of 200^. per head, 
for the persons whom they will accommodate. It is 
true that Lunatics cannot be properly taken care of in 
the manner in which paupers are provided for; and there 
are many expensive arrangements essential to a Lunatic 
Asylum, which are not required in a Workhouse. We 
have been informed that nearly half the expense of 
an Asyhim is caused by the number of separate cells, and 
by making the building fire-proof; whereas if ordinary 
dormitories, sufficiently large to contain a moderate num- 
ber of patients, were principally used, and that part of 
the house most exposed to danger only were made fire- 
proof, a large proportion of the cost might be saved. 

In reference to the question, whether many single cells 
are necessary or not, we observe that the larger pro- 
portion of patients in almost every County Asylum have 
separate cells, whilst in almost all private Houses licensed 
for paupers, single cells are rarely used, except for a few 
of the more violent and dangerous inmates ; the general 
body of the patients sleeping in dormitories containing 
several beds, varying in number according to the size 
of each room. In 1842, some of the corridors at StaflPord, 
owing to the crowded state of the Asylum, were converted 
into dormitories, and divided by folding partitions, which 
allowed perfect ventilation when closed at night. At 
Lincoln a large proportion of the patients' beds are 
placed in galleries, an arrangement that is considered to 
be advantageous, and in all the large County Asylums 
there are some sleeping-rooms containing numbers of 
beds. We have seldom seen any sleeping rooms for 



13 

paupers more comfortable, and more cleanly or better 
ventilated, than some of the dormitories in the Licensed 
Houses at Bethnal Green, Fairford, Devizes, and Market 
Lavington, each of which contains seven or eight beds, 
or more. 
The dormitories in these and in some other licensed Comfoit and 

. advantage of 

Houses appear to us to possess every comfort which Dormitories, 
the paupers either wish for or require. They, more- 
over, better accord with the pauper s previous habits 
than sleeping alone in a solitary cell with a single 
window ; and the companionship of others in the same 
room does not seem to interfere with their nightly rest. 
"We rarely visit a licensed House containing paupers 
without asking some of the patients how they sleep at 
night, and we are generally answered that they sleep 
well. These persons almost invariably occupy sleeping- 
rooms containing several beds. In many good Licensed 
Houses, also, private patients, of a superior class, 
frequently sleep, to the number of four or five, or even 
more, in separate beds in the same room. Upon the 
whole, we are of opinion that dormitories containing 
several beds are much preferable, as a general arrange- 
ment, to cells or single-bedded rooms ; although a limited 
number of the latter is doubtless necessary in every 
large Asylum, for the use of violent, noisy, and mis- 
chievous patients, and for such as are labouring under 
a paroxysm of insanity. The introduction, however, of Great number 
any great number of single cells in an Asylum is objec- objecUonaWe! 
tionable, by reason of the space which they occupy, and 
of the expense incident to their erection ; to which may 
be added the circumstance of their small guarded win- 
dows giving a gloomy character to the building. For, 
when so much is in operation to afford cheerfulness and 
remove restraint within, it may not be without advan- 
tage to abolish the prison-like aspect which marks the 
exterior of some of the old Asylums. 

The question whether Lunatic Asylums for Paupers 



14 



Question 
whether Asy- 
lums forPaupers 
should be fire- 
proof. 



Site and con- 
struction of 
County Asy- 
lums. 



Requisites 
enumerated. 



should be made fire-proof, has been brought under our 
consideration, and is specially connected with the sub- 
ject of the cost of these buildings. The Public Hospitals 
for the Sick in London and in the country, and the large 
Public Hospitals for the Insane, at Northampton, York, 
Exeter, and elsewhere, are not built fire-proof; and of all 
the private licensed Houses for the Insane, we know of 
only two which have been so built.* The importance 
of rendering the building fire-proof is obviously in- 
creased if a large proportion of the patients sleep in 
separate cells ; for, in the event of a fire, the difficulty 
of unlocking a great many doors would much impede 
the removal of the patients to a place of safety. 

Having called your Lordship's attention to the ques- 
tion of the cost of County Asylums, we now proceed to 
remark on the site for such buildings, and on what is 
necessary in their construction, in order to render them 
fit for the reception of Lunatics. 

An Asylum should be placed upon elevated ground, 
and should command cheerful prospects: the soil 
should be dry, and there should be a plentiful supply of 
water, and means of proper drainage. The want of 
water, in places where large numbers are collected, of 
whom many are invalids, and many extremely dirty, is 
obviously a serious calamity. The buildings should 
be surrounded with land sufficient to afibrd out-door 
employment for the male, and exercise for all the 
patients, and to protect them from being over-looked, or 
disturbed by strangers. In the best asylums (such as 

* It is singular that in one of these houses two, and in the other 
one person, have lost their lives by fire in their separate rooms. There 
was a fire at the York Asylum, in the year 1813, in which four per- 
sons lost their lives. There has also heen a slight fire at the Gloxices- 
ter Asylum, in the main building, and in a gas house at Hanvvell, but 
no accident happened, and little excitement took place anaong the 
patients on the happening of either of these events. 

After the Surrey Asylum was made fire-proof in the part occupied 
by the patients, the chapel was required to be made fire-proof, and 
this was effected at a very considerable additional cost. 



15 

those for the counties of Surrey, Kent, and the West 
Riding of Yorkshire) these and other important mat- 
ters* have been attended to ; but in others they have been 
partially or wholly neglected. 

St. Peter's Hospital, Bristol, is situate in the centre of St, Peter's 
the most crowded part of the city, and has for the pur- 3^510/ ' 
poses of exercise, only half of a small paved court for 
the males, and for the females an equally small court, 
used, also, as a road, and which is, in every respect, 
quite unfit for the purpose to which it is appropri- 
ated. The Asylum for the county of Pembroke, at Asylum at Ha- 
Haverfordwest, was once a town Gaol, and, in its ' 

present state, is an ill-constructed Prison. For its total 
unfitness for the care of pauper lunatics, we must refer to 
the description of it, in a subsequent part of this Report. 
The site of the Asylum at Nottingham is partly sur- Nottingham ; 
rounded, and commanded by adjoining buildings. It 
contains 177 patients, but has not more than three 
acres of land, besides what is occupied by the build- 
ings, garden and yards, and we understand that there 
is no opportunity of purchasing any more adjoining 
ground. The present medical superintendent himself 
took a farm, for some time, with the view of finding 
employment for the male paupers, but his other duties 
prevented his continuing to occupy it. Inconvenience 
has been experienced at the Asylum for Dorset, and Dorset ; 
at Lancaster, from the yards and wards being too Lancaster; 
close to the boundary wall. At Hanwell, the ward Hanwell ; 
for the worst class of females, and the large exer- 
cising ground for the women, are both liable to the 
same annoyance, being only separated from the land 
of other proprietors by a wooden paling. At Leicester, Leicester ; 

* The Galleries and Day Rooms at the Leicester and Dorset 
County Asylums, are very good. The Yards of Gloucester, and the 
Grounds at Hanwell, are spacious and very well adapted for exercise. 
Many of the arrangements at Stafford have been much approved ; and 
amongst other important advantages, the Kent and Lancaster Asylums 
have detached Infirmaries for each sex. 



]6 



Norfolk ; 



Lancaster : 



Bedford. 



Want of water 
at Bodmin ; 



Lancaster and 
Han well. 



Importance of 
warmth, venti- 
lation, Si.G. 



containing 131 patients, there are only four or five 
acres of land, besides the site of the buildings. 
The Norfolk Asylum, with 220 patients, has only 
five acres of land, of which not more than one acre 
and a half, used as a kitchen garden, can be applied to 
the employment of the patients. At Lancaster, where 
there are 611 patients, they had originally only five 
acres, subsequently increased to fifteen; and last year 
the magistrates of the county were obliged to apply 
to Parliament for, and obtained an Act to enable them 
to purchase the additional land, which was essential 
for the proper care of their patients. At the Asylum 
at Bedford, with 139 patients, there are only six 
acres, besides what is covered by the buildings and 
yards, part of which is used as a burial ground. The great 
value of out-door occupation as a means of restoring the 
insane poor, (even those whose employments have been 
previously sedentary,) to health of mind, and of promot- 
ing tranquillity, renders the want of a sufficient quantity 
of land a very serious defect in the above-mentioned 
Asylums ; and thisj in some instances, cannot be 
remedied without removing the Asylum altogether. 

The Asylum of Bodmin is frequently short of water, 
and had been so during a whole week at the time of 
our visit to it in 1843, when the discomfort and evils 
resulting from this deficiency were very perceptible. 
There has also been considerable difficulty about the 
supply of water at the Lancaster Asylum. At Han- 
well, one well has failed, and this large establishment 
was mainly dependent on the Grand Junction Canal 
for its supply, which was obtained at a cost, during 
several years, of 1401. a year ; but the Company having 
refused to continue the supply, the Visiting Justices 
have been compelled to sink an Artesian well, whifli 
has cost 1,483^. 

The importance of warmth, ventilation, and dryness, 
in Limatic Asylums, will be understood by the fact 



17 

that at Stafford, as was stated to us, in 1842, that " an 
improved system of warming and ventilation had been 
recently introduced with success, since which no cases 
of dysentery, formerly prevalent, had occurred ;" and 
at the Dorsetshire Asylum, in 1843, we were informed, 
that, " from the floors having been damp, the patients 
were formerly subject to dysentery, but they had been 
taken up and relaid, and not one of the patients 
admitted since the alteration had suffered from dysen- 
tery." Many Lunatics are not only sickly, but are so 
filthy in their habits, that they nearly frustrate all 
attempts to keep them clean, and can only be allowed 
to sleep upon straw or other bedding which may 
be thrown away, or washed every day. In cases of 
this sort, a free circulation of air is very important. 
The ventilation at the Asylums for the counties of 
Kent, Surrey, and some others, is very good; whilst at 
Hanwell, and at Bodmin, it is in some parts extremely 
defective. 

It is indispensable to the comfort and health of the 
inmates of Lunatic Asylums, that proper provision should 
be made for warming and ventilating the Galleries and 
Dormitories, so that the Patients may breathe a pure 
atmosphere, of a moderate and even temperature. It is 
also essential to their enjoyment, that the interior of the 
building should be light and cheerful. A large propor- 
tion of the Patients, more particularly the Females, spend 
a great part of the day in the Wards ; and it is verv 
desirable that the Galleries should be so constructed and 
lighted as to form convenient places of exercise and recre- 
ation in rainy weather, and in the winter season. It is 
especially important that these considerations should be 
kept in view, in the erection of Asylums. If they are 
neglected in the first instance, much additional expense 
must be incurred in remedying the original defects : 
whilst the evils arising from tainted air, and an unequal 
c 



IS 



Arrangements 
for warming 
and ventilation 
in Asj'lums 
visited. 

Steam Appa- 
ratus, &c. 



Advantage of 
open fires. 



Mode of warm- 
ing Chester 
Asylum ; 



Nottingham 
Asylum ; 



Leicester Asy- 
lum : 



temperature, can, in many cases, be only partially abated 
by subsequent alterations. 

We have endeavoured to ascertain, as regards Wanning 
and Ventilation, what arrangements are made in the 
several Asylums which we have visited, and what plans 
have been found, most successful. 

The mode of warming frequently adopted is by means 
of a circulating steam or hot-water apparatus, which, in 
the older Asylums, has, in most instances, been substi- 
tuted for the open fires, or stoves, formerly in use. 

In adopting this arrangement, consideration has been 
had to economy of fuel, to the saving of trouble to the 
Attendants, and to lessening the risk of danger to the 
inmates ; but open fires have the advantage of cheer- 
fulness, and chimneys materially promote ventilation 
at those seasons of the year when artificial heat is not 
required. In the Chester Asylum, on the occasion of 
our first visit, in August, 1842, we found open fires still 
in use on the Female side, principally, as we were in- 
formed, with a view to the enjoyment of the Inmates, 
who much preferred them to a heating apparatus, as 
being more cheerful. The Male Division was warmed 
by means of hot-water pipes, passing through the upper 
Galleries ; the furnace to the boiler answering the purpose 
of a Stove for the Basement Story, in which the Patients 
of uncleanly habits were placed. 

At the Nottingham Asylum, steam pipes have been 
substituted for a hot-air apparatus, the latter having 
been found ineffectual for its purpose. The steam is 
generated by the boiler of an Engine, by means of which 
water is pumped up into a Reservoir above the level of 
the upper Galleries. Over this Boiler is an excellent 
Drying Room. 

The interior of the Leicester Asylum is '' warmed 
by atmospheric air conducted in brick drains, and passed 
over iron plates and pipes made hot with boiling water ; 



19 

and the air, when heated, is conveyed by brick tubes to 
the several Dormitories and Galleries, and the vitiated 
air is allowed to escape through Conductors into the 
roof, from whence it is discharged by turn-caps, or 
cowls, regulated by vanes." 

At the Kent Asylum, the warming and ventilating Kent Asylum 
arrangements were designed and carried into execution 
at the time the Buildings were erected, and consist (as 
described by the Architect) of " a large volume of pure 
atmospheric air, passing from the yard, through channels 
under ground, into a Chamber where it is warmed in 
winter, by passing over a large surface of hot- water pipes, 
and from thence enters the Galleries in a large volume 
near the ceiling, and into the Sleeping Rooms. — It is 
from thence drawn off through apertures near the floor, 
and into air drains which communicate with fires in 
the Cellar, thus ensuring a constant change'of the air, 
as the fires are supplied entirely by the vitiated air from 
the Galleries and Sleeping Rooms." The apparatus has 
been in use several years, and has been found to answer 
perfectly. The Superintendentj to whom we are indebted 
for the foregoing particulars, adds that hot water is the 
medium used for warming the air in the new Building ; 
but that in the old Building, the air is warmed by a 
cockle and tubes, the principle in other respects being 
the same. Hot- water tubes or pipes are consiered by him 
preferable to the latter, " as the air cannot be heated 
above the temperature of boiling water, and conse- 
quently is never burnt." 

In reply to our inquiries at the Gloucester Asylum, Glouceeter 
we have received from the Superintendent the following *^ "™ ' 
statement : — " In the Refractory Wards, the Sleeping 
Rooms are both warmed and ventilated by air passing 
through chambers, inclosing pipes of warm water. The 
same principle is here adopted as at the Pentonville 
Prison ; and was one of Mr. Haden's first attempts to 
effect the circulation of warm air from above down- 
c2 



20 

wards. It is very good, and answers extremely well." — 
Upon two several occasions, however, when this Asy- 
lum was visited by the Commissioners, the ventilation 
of the Basement Story, especially in the cells appropri- 
ated to the dirty class of Patients, appeared to be 
extremely indiflferent. 

Surrey Asylum; In respect to the Surrey Asylum, (the last County 
Asylum which has been erected,) the House and Galleries 
generally are warmed by the circulation of Steam, and 
the introduction of Hot Air through apertures in the 
floor. The temperature is regulated by stop-cocks, 
and kept between 56° and 58°. There are open fires, 
with proper guards, in the several Day Rooms on the. 
Female side ; and it is proposed to adopt them also in 
the Male division. We drew the attention of the Super- 
intendent to the defective ventilation of some of the 
Pauper Dormitories on the third floor, which we were, 
informed by him had also been noticed by the Visiting 
Justices. 

We have elsewhere adverted to the want of proper 
ventilation in some of the Wards or Sleeping Rooms 

Ha iwell Asy- in the Hanwell Asylum, more especially in the Base- 
' ment Story on the Female side. And we have, when 
visiting other Asylums, pointed out similar defects to 
the Superintendents and Medical Officers. 

St. Luke's Hos- The Galleries in St. Luke's Hospital, which are spa- 
* cious and airy, are not artificially warmed; and com- 

plaints were made to us of their being cold in winter. The 
only fires in the Wards are those in the Day Rooms and 
Nurses' Apartments. We were informed, however, that 
plans were under consideration for the introduction of a 
hot- water apparatus, with grated openings in the lower 
part of the doors of the Sleeping Rooms. The ventila- 
tion of these rooms, when we visited the Hospital, ap- 
peared to be imperfect. 

Lincoln A.sy- At the Lincoln Asylum ; the Day Rooms, of which 

there are eight in each division of the Asylum, are 



21 

warmed by open fires. The Galleries, which appeared to us 
as likely to be very cold in winter, are not artificially 
warmed, the stoves and flues formerly in use having been 
discontinued in the year 1836. Upon this subject, the 
Board of visitors, in January, 1843, amongst other 
Regulations for the Medical Treatment of the Patients, 
passed the following Resolution : " That no system of 
warming this house, by means of which the Patients 
may breathe a heated atmosphere, be introduced." 

We proceed to offer a few observations upon the size Observations on 

J i p ^^ T\ -i • J • 1 oi • dormitories snd 

and arrangement of the Dormitories and single Sleeping ^-^^ ^^jj^ 

Cells. In respect to the latter, it appears desirable, 
on every account, that they should be on only one 
side of the Gallery, and that they should not be ranged 
back to back, as is the case at Lancaster and Glou- 
cester. Galleries, with Sleeping Rooms on both sides, 
are generally gloomy, and the ventilation is necessarily 
imperfect. Where the original construction of the 
Asylum, or the number of Patients to be accommodated, 
renders such an arrangement unavoidable, it is desirable 
that recesses extending to, and lighted by windows in the 
outer wall could be left at intervals between the sleeping 
rooms, so as to form part of the galleries, the ventilation 
and general cheerfulness of which will be thereby mate- 
rially promoted. Light should also, in all cases where 
it is practicable, be admitted at the extremities of the 
Galleries. The Galleries in the Surrey Asylum, in Galleriea in 
which thei'e are Sleeping Rooms on both sides, are wide 
and airy ; those on the upper floor being well lighted 
by cupolas. This plan, in some degree, diminishes the 
force of the objections that we have stated. 

Upon the subject of single Rooms as connected with ven- Dormitories 
tilation, we would observe that, unless they are perfectly P.'^^f ^^^^ '" 

' ^ J r J single rooms. 

ventilated. Dormitories, with a limited number of beds, 
are preferable. Such Dormitories present the advantage of 
a more free circulation of air, and more even temperature. 
Single Rooms, where adopted, should be of good size. 



22 

Those in the new Wings at the Bedford Asylumj 
which are constructed only on one side of the Galleries, 
are of inadequate dimensions, being only six feet six 
inches in length, by six feet in width, and about eight 
feet high. We found them, however, clean and free 
from any offensive odour. The usual size of the single 
Cells in County and Public Asylums is from nine to ten 
feet in length, and seven feet in width; and the ave- 
rage solid measure of each is about 700 cubic feet. 
Use of base- The USB of basement stories below the level of the 

ment stories Tot t . . jiiii -jj i 

Patients to be adjoining ground should be avoided as much as pos- 
avoidcd. giijie foj. occupation by Patients. They are used in 

the Suffolk Asylum and at Nottingham and Hanwell. 
Some of the cells on the basement floor at Nottingham 
can scarcely be considered as fit for invalids ; and many 
of the sleeping-rooms on the basement story at Han- 
well, are dark, cold, and ill ventilated. Much has been 
done at the Surrey Asylum to render the basement 
story cheerful and airy, by making the windows open 
upon green grass slopes, instead of into areas ; and the 
same plan has, also, been partially adopted at Hanwell. 
An Asylum An Asylum should have cheerful and spacious day 

cheerful and rooms, easily accessible from the yards. An opinion was 
spacious day expressed by the Resident Physician of Hanwell, before 

roouaS. , fiTT p T ^ ^ • 1 ' 

a Committee of the House of Lords, that it was desir- 

Use of galleries able to have the day rooms formed in the galleries: but 

as day rooms ; ^|^g ^j^her Medical Officers and Engineer of that Asylum 

did not, on our mentioning the subject, concur in this 

at Hanwell ; opinion. One of the galleries for females, in Hanwell, is 

in the form of three arms of a cross, and has one arm 

Bodmin ; entirely occupied by a table and benches. At Bodmin, 

the day rooms generally form parts of the galleries, and 

partitions have been erected to keep the patients away 

from their bed rooms in the day time, and to prevent 

the smell and inconveniences resulting from their 

using the galleries as dining rooms. 

Kfent Asylum. la the Kent Asylum, the galleries constitute the 



23 

only day rooms for the patients, an arrangement which 
we think of very doubtful advantage in this otherwise 
excellent establishment. Galleries are intended as places 
for exercise for invalids, and for all the patients in bad 
weather, and the necessity of placing chairs and tables 
in them, and the preparations and removals before and 
after meals, greatly interfere with this object. 

The yards of Asylums should be constructed so as to Constructiou of 
have as much light, sun, and prospect as possible. With ^^^ ^' 
this view, there were raised, in the yards of the Asylum 
at Wakefield, (erected in 1815,) mounds affording a view 
of the country over the walls. Similar but more per- 
fect arrangements have been made since at the Surrey, 
Lancaster, and other Asylums. The yards, however, at 
Bodmin, Nottingham, and Leicester, are for the most 
part dull and gloomy, from being surrounded by high 
walls. Many of the yards at Hanwell are enclosed by 
walls and buildings, and some are placed between the 
main building, the farm-yard and piggeries. The 
yards in the Asylum for the county of Norfolk, 
are extremely defective ; and those in the Asylums for 
the counties of Dorset and Kent, are not cheerful or well 
laid out. Every yard ought to contain a shed for shelter 
from the sun. 

Another point connected with the construction of Limitation of 
county Lunatic Asylums, and which requires much T^ f County 
attention, is the size to which each should be limited. 
Out of fifteen coxmty Lunatic Asylums already erected, 
ten have accommodation for not more than 200 
patients, whilst the remaining five have room for larger 
numbers. The Asylum for Kent will contain 300 ; for 
Surrey, 360 ; for the West Riding of York, 420 ; for 
Lancaster, 600 patients ; and the Asylum for Middlesex 
has beds for 1,000 patients. From the best opinions 
that we have been able to collect, and from the result of 
our own observations and experience, we think it is 
desirable that no asylum for curable lunatics should should not con- 

, 1 nr • 11 • *^'° more than 

contam more than 250 patients, and that 200 is perhaps 250 patients. 



24 



Magnitude of 
Hanwell incon- 
venient. 



Consequences 
of disuse of 
restraint. 



as large a number as can be managed witb the most be- 
nefit, to themselves and the public, in one establishment.* 

It has been generally considered to be an advantage 
in England, that our public hospitals are less in size 
than they are in France and on other parts of the Con- 
tinent, and that the patients are on this account better 
attended to in our hospitals. "We have, in other parts of 
our Report, alluded to some evils and inconveniences 
which have been experienced at Hanwell, owing to its 
extreme magnitude. The two resident Medical Officers 
have, between them, nearly 1,000 patients to attend, 
and are required by the rules to see every patient 
twice a day. Each of these Officers has an average 
of 30 persons on the sick list, and about 50 on the 
extra-diet list. Besides these duties, they have to mix 
the medicines, and to keep the registers and diaries. 
Some attention is also required to be paid to chronic 
cases, in which the general health and state of mind are 
often varying. This Asylum contains 100 officers 
and servants, residing in the buildings besides employing 
between 50 and 60 out- door labourers and mechanics. 

The diminution and disuse of restraint in Asylums 
have been accompanied by an increase in the number 
of attendants, and by confiding to them a greater 
power of control over the patients. The delegation of 
so much authority, as, in large asylums, is now neces- 
sarily placed in the hands of attendants, demands a 
proportionate increase of vigilance in the Superintend- 
ents. At Hanwell, much importance is attached to 
having a superior class of attendants, to be employed 
in carrying into effect the system of management which 
exists there ; but we found that a large proportion of the 
female attendants had been in the Asylum only a short 
period, and had not previously been employed in any 

* The Legislature has recognised the expediency of limiting the size 
of Asylums by enacting (1 and 2, Geo. IV., c. 33), that the District 
Asylums in Ireland, " shall be sufficient to contain not more than 
150" Patients. 



25 

similar establishment. There is, however, sometimes DifBculty in 
great difficulty in finding good attendants for Asylums, attendants • 
and where more than eighty are employed, it is pro- 
bable that there must necessarily be frequent changes. 
We think that the assembling, under one roof, of so 
many patients and servants, as are now in Hanwell 
Asylum, is calculated to render it difficult to main- 
tain that order, regularity, and subordination, which are and of main- 

„ taining oider. 

essential to the good management of a receptacle for 
the insane. These considerations are especially import- 
ant at a time when, as we are informed, there exists an 
intention to increase the Asylums (already so large) for 
the Counties of Middlesex and Lancaster. "We trust 
that the Magistrates of those districts will deliberate 
seriously before they resolve upon a measure of such 
doubtful expediency. 

By the Act 9 Geo. IV. c. 40, sect. 8., it is enacted Election of 

Committee of 

that, in the case of every County Asylum "it shall be visiting justices 
"lawful for the maior part of the Justices of the Peace, "' °"°'y • 

J i ' Asylums, under 

" at the Michaelmas General Quarter Sessions in each 9 Geo. IV. c. 

40 s. 58. 
" year, to elect a Committee of Visiting Justices, for the 

"Management of such County Lunatic Asylum, and to 

" fill up any vacancy in the number of such Committee as 

" may have occurred by death, or resignation ;'' and by 

the 30th sect, of the same Act, the Visitors are required 

" from time to time, to make regulations for the man- 

" agement and conduct of the Asylum ; in which regu- 

*'lations shall be set forth the number and description 

" of Officers and Servants to be kept, arid their respec- 

" tive duties and salaries ;" such Officers and Servants 

to be appointed and dismissed by the Visitors. The Regulations fre- 

first of these provisions appears to be in general complied i^^^^ ^ °^^" 

with, but the regulations are frequently neglected to be 

made. 

In the Asylum for the County of Bedford, however, 

there seems to be no Committee elected ; the whole body 

of Magistrates being appointed Visitors, and almost the 

entire control of the County Asylum being delegated to 



26 



Appointment 
and dismissal of 
servants. 



Rules for ma- 
nagement of 
County Asy- 
lums left by 
law entirely to 
Magistrates. 



General rules 
desirable. 



Publication of 
annual accounts 
important. 



Rules for relief 
of certain pau- 
per lunatics 
when discharged 
important. 



the Medical and General Superintendent, who appoints 
and dismisses servants, and occasionally discharges 
patients of his own authority. There is also no set of 
rules, for the direction of the officers and servants of this 
Asylum. We consider that the appointment and dis- 
missal of servants is a trust of great importance, which 
is vested in the Visiting Justices for the purpose of 
checking any undue power or influence being used by 
the superintendent over the servants of an Asylum. 

In the County of Chester, at our first visit, no Com- 
mittee of Visiting Justices had been elected, but all the 
Magistrates acted as Visiting Justices. They seldom 
visited the Asylum, the superintendence and manage- 
ment of vphich was confided, until lately, almost ex- 
clusively, to the Visiting Physician, upon whom a very 
serious responsibility was thus thrown. In some other 
Asylums, the hiring and dismissal of servants appear to 
be entrusted to the Medical Superintendent and Matron. 

The law has left the formation of rules for the manage- 
ment of County Lunatic Asylums entirely to the Magis- 
trates. Whilst these institutions were comparatively new» 
this might be unobjectionable ; but now that they have 
become numerous and of great importance, and are 
maintained at a large public cost, we think that some 
general rules should be laid down for their management, 
and some uniform but concise tables framed for their use, 
in order to their making periodically certain statistical 
returns. It is important that an account should be 
published of the annual expenditure of every County 
Asylum, (as is already done in many cases,) as well 
as of the original cost, and all the current expenditure, 
in proper detail. Some opinion might then be formed 
as to the comparative good management and efficiency 
of each of these Asylums. We think it of importance 
that some rules should be laid down for the relief of 
certain Pauper Lunatics when discharged. Pauper 
Lunatics who are sent from a Parish, or a Workhouse, 
have> on being discharged, either their own home 



27 

or the Workhouse to return to, until they can find 
employment and the means of subsistence. Paupers, 
however, whose Parishes are unknown and who are sent 
as County, or Vagrant Paupers, and are maintained at 
the charg-e of Counties, have, frequently, on being dis- 
charged, no home or Workhouse to which they can 
resort until they can obtain work. Our attention has 
been called to this subject, on more than one occasion. 

At the Bethnal Green Asylum, whenever any County Practice at 
Pauper has been discharged as cured, it has been the ^^'^"^^ ^""^f.^ 

■r o ' Asylum on dis- 

custom, if the Patient has conducted himself well, to charge of Pau- 

, . . . , , , per Lunatics. 

gjve him permission to return to sleep and have some 
meals, until he can find employment. This has been 
charitably allowed from a conviction that such persons, 
if suddenly turned adrift without a home, or the means 
of procuring food, would, in most cases, be soon sent 
back under a relapse brought on by destitution. When 
it is stated that in 1842 there were, in the County Asy- 
lum of Lancaster, 118, and in 1843, in the County 
Asylum for Middlesex, 126 County Paupers, or 
Vagrants, who, upon their discharge would have no 
Workhouse, and probably no home to repair to — it 
will probably be thought worth while to make some Some provision 
provision for Patients of that class in the event of their uent^necessary. 
liberation. 

The destitute condition of many Pauper Lunatics on Charitable 
leaving Asylums, has induced benevolent individuals to of discharged 
raise funds for their assistance. A gentleman of the P*"P^i' Luna- 
name of Harrison left a sum of 1000^. to the Asylum 
at Wakefield for this purpose. The Adelaide fund 
having the same object, was set on foot by the chari- 
table exertions of the Visiting Magistrates at Hanwell, 
and in 1842, amounted to 5000/. At the Gloucester 
Asylum, where there is a similar fund, amounting to 
about 800/,, small sums of money and occasionally 
also tools, are lent to Patients on their liberation. 
There is a similar fund, instituted by Lady Middleton, 
at Nottingham ; and upon the same principle, assistance 




28 



Rule adopted 
by Middlesex 
Magistiutes as 
to Pauper 
Lunatics' settle- 
ments. 



Recommenda- 
tion as to ap- 
pointment of 
resident Medi- 
cal Officer in 
Public Asy- 
lums; 



and Visiting 
Physician in 
County Asy- 
lums. 



IS given to poor Patients on their discharge at St. Luke's. 
It may deserve consideration whether, some arrange- 
ment should not be adopted generally with a view to 
provide assistance for poor Patients on their discharge. 
Relapses are frequently attributed to the want of some 
such relief. 

At the suggestion of the Visiting Justices of Hanwell, 
the Magistrates of the County of Middlesex have agreed 
not to adjudicate Paupers as County Patients, without 
previous notice to the County Solicitors, and a minute 
investigation of each case. The result of this judicious 
arrangement has been, that the Settlements of many 
Paupers, previously charged upon the County, have been 
discovered, and a considerable saving to the County has 
been thus effected. 

By the Act 2 & 3 Will. IV. c. 107, every licensed 
Asylum containing 100 patients (or more), is required to 
have a resident Medical Officer, and it is important that 
a similar regulation should be made in reference to 
Public Asylums. It is to be observed that all the County 
Asylums possess resident Medical Officers, except those 
of the counties of Bedford, Norfolk, and Pembroke, 
(Haverfordwest). We think it, also, in many cases, 
desirable that County Asylums should have a Visiting 
Phvsician, in addition to the resident Medical Officer. 

In the case of the Asylum at Hanwell, the Visiting 
Justices have lately appointed a gentleman (formerly an 
Officer in the Army), who has had no previous expe- 
rience in the management of the Insane, as the Governor. 
The appointment appears to have become necessary in 
order to preserve good order in this large Establishment ; 
and for that purpose, the Governor has the power of sus- 
pending, not only the servants, but even the Medical 
Officers and Matron of the Asylum. He has also the 
entire control over the classification, employment, amuse- 
ments, instruction, and general management of the 
patients both male and female, subject only to the 
general control of the Visiting Justices. 



29 

It is apparent, from the foregoing remarks, that General re- 
althoUgh a few of the existing County Asylums are ^v Asylums. 
well adapted to their purpose, and a very large pro- 
portion of them are extremely well conducted; yet 
some are quite unfit for the reception of the insane, 
some are placed in ineligible sites, some are defi- 
cient in the necessary means of providing out-door 
employment for their paupers, some are iU-contrived 
and defective in their internal construction and accom- 
modations, some are cheerless and confined in their yards 
and airing- grounds, and some are larger than seems ' 
consistent with the good management of their establish- 
ments and the proper care and health of their patients. 
"When in addition to these defects in the Institutions 
themselves, the very large cost at which they have been 
erected is taken into account, it appears to be deserving 
the consideration of the legislature, whether the erection 
of Public Asylums for the insane poor of the country 
may not be advantageously regulated by some inde- 
pendent authority. Although county magistrates have 
properly the control of the expenditure of funds to be 
raised in their own districts, it can scarcely be expected 
that they should devote so much attention as is really 
necessary to make them conversant with the various 
points which involve the convenience, comfort, and 
security necessary to be provided for in large Asylums 
for the insane, and they are therefore liable to be misled 
as to their proper cost and construction.* 

• Surveyors and architects should be especially directed to visit the 
best constructed Lunatic Asylums, previously to the preparation of 
plans for new Establishments. The plan of the Asylum for the 
County of Devon, not yet opened, has been much objected to : it 
is somewhat similar to that of the Lunatic Asylum for the County 
of Cornvcall, which has been found ill suited to the purposes for 
which it was erected. Whilst visiting the Asylum at Hanwell, 
we met several parties examining the buildings, with a view of 
preparing plans for a Pauper Lunatic Asylum for the County of 
Derby ; and from perusing the printed minutes of a Committee of - ' ^ 

Magistrates of that County, we fear that they have been led to adopt 
some of the defects of the Hanwell Asylum. 



30 

Pauper Lunatics have unfortunately become so 
numerous, throughout the whole kingdom, that the 
proper construction and cost of Asylums for their use, 
has ceased to be a subject which affects a few counties 
only, and has become a matter of national interest and 
importance. 



Asylums erected 
under 48 Geo. 
III. c. 96, and 
9 Geo. IV. c. 40. 



Weekly pay- 
ments for pau- 
pers in certain 
County Asy- 
lums. 



2. — County Asylums, partly supported by 
Contributions. 

In respect to the Asylums for the counties of Corn- 
wall, Gloucester, Leicester, Nottingham, and Stafford, 
which have been established at the joint expense of 
counties and subscribers, it is to be observed that they 
were erected under the provisions of the Acts 48 Geo. 
III. c. 96, and 9 Geo. IV. c. 40. From the recitals 
in the former of those Acts, the intention of the Legis- 
lature appears to have been to encourage Asylums of 
this description ; first, on the ground of the payments 
of the richer being applied towards the maintenance of 
the poorer classes of Patients; and secondly, on account 
of the advantages which they were likely to afford to 
Pauper Lunatics. 

We have not been able to ascertain, with accuracy, 
what has been the extent of the relief contributed in 
these Asylums to the poorer private Patients, from the 
excess of the payments of the richer private Patients, and 
we are therefore unable to say, how far the charitable 
objects of the Legislature have been realised in this 
respect. But, as regards the advantages which have 
been conferred by these Institutions upon Pauper Luna- 
tics, it appears to us that they scarcely equal those of 
County Asylums erected exclusively for Paupers ; whilst 
the maintenance of Paupers in them is fully as expen- 
sive as in Asylums established solely for paupers. 

In the Asylum for the county of Cornwall, the pay- 
ments of the higher classes of private patients are 
applied in diminution of the expenses of the paupers. 



31 

for whom the weekly payment is 5^. 6d, The weekly 
payment for paupers at Leicester, is 8*. 6d.; and at 
Staflfbrd, 7*., in each case, exclusive of clothing ; and at 
Gloucester, 9*. and at Nottingham, 8*., including 
clothes. In some of these Asylums, the better part of 
the buildings and airing grounds are given up to the 
private patients, to the exclusion, in a great measure, of 
the paupers. 

It is right, however, to observe, that the defects of Contributors 
some of these Institutions maybe attributed to their c° /" sen ers 

•' tii'st promoters 

having been amongst the first Public Asylums that were "f » ™il<i 
erected, and that the contributors and subscribers to 
them were amongst the first promoters of a mild and 
humane system of treatment for the insane of all 
classes. "Whether Institutions may be formed, in which No opinion 
private patients shall have all the comforts which their ^^^^^^ ^^ *" 

* '^ formation of 

circumstances afford, and the poor may also be properly improved mixed 
taken care of at a diminished expense to the country, 
is a question upon which we do not at present offer an 
opinion. 



3. Military and Naval Hospitals. 

The Military Hospital at Fort Clarence, near Chat- Military Hos- 
hara, is well situated. That part of the fort which is appro- ciarence de- 
priated to the residences of the Officers is very gloomy, scribed. 
and ill suited for a receptacle for Insane persons. Some 
of the sleeping-rooms for the private soldiers are suffi- 
ciently good, but others are dull and cheerless. The 
exercising-ground for the Officers, and the yards for the 
soldiers, are cheerful, but are not sufficient in number 
or size. The buildings and grounds admit of great 
improvement ; but we understand that the inmates of this New Asylum 
Hospital are about to be removed to a new Asylum. opened." 

That part of the Naval Hospital at Haslar which is Naval Hospital 
set apart for Officers of the Navy and seamen afflicted 
with Insanity, is admirably adapted to its purpose. The 



32 

rooms are lofty, spacious, and airy ; and they command a 
view of the entrance to Portsmouth harbour. There are 
excellent exercising-grounds between the Hospital and 
the shore, and the Patients are frequently taken out in 
boats. 



General re- 
marks on Public 
Hospitals. 



Guy's Hospital, 
and Bethel at 
Norwich. 



Comparative 
receipts from 
private patients. 



Advantages en- 
joyed by them. 



Payments at 
Lincoln and 
Northampton 
for paupers. 



4. Public Hospitals, supported wholly or 
PARTLY BY Voluntary Contributions. 

Having obtained authority from your Lordship to visit 
the different Lunatic Hospitals in the kingdom coming 
under this class, it will be expected that we shall make 
some remarks upon their condition. These Hospitals 
differ materially from other Hospitals for the Sick in this 
respect, that although most of them derive some portion 
of their income from a charitable foundation, the patients 
admitted into them invariably pay the greater part, and 
sometimes the whole, of the expense of their own main- 
tenance and medical attendance. The Lunatic Ward 
of Guy's Hospital, and, to a certain extent, the Bethel 
Hospital at Norwich, are exceptions to this rule. The 
sum received from private patients, and for board and 
lodging, in the year 1842, at the Retreat, York, was 
4l39;.2.s. lie?.; at St. Luke's, 1526Z. 8*. ; at Lincoln, 
(1843), 3559^. 19s. Ud.; at Exeter, 1735^.; at the 
Warneford, near Oxford, 1098L 10*. 6d. : and at North- 
ampton, 514U. 18*. 5d. Private patients who have been 
in better circumstances, derive much benefit from the 
comforts and advantages which these Institutions supply, 
at a moderate rate of payment. 

There were eighty- three pauper patients, in 1843, at 
the Lincoln Asylum, for whom the payment made by 
their parishes was 10*. per week for each person, and at 
Northampton there were 192 paupers, for whom the 
payment was 9*. per week for each person, not in- 
cluding clothes in either case. These sums are higher 
than are usually charged for paupers in licensed houses. 



33 

The founders, however, of these Institutions did not 
intend them for the benefit of rate-payers. 

The internal accommodations and grounds of the Comparative 

, . , , accoinmoda- 

Retreat, near York, are admirably adapted to promote tions. 
the benevolent objects for which that Asylum was 
established. The Lincoln Asylum is extremely well 
situated, and the buildings are commodious and well 
suited to their purpose, but at the time of our visit, 
there was no land for employment. Some of the rooms 
at Exeter are cheerful, and command good views, but the 
yards are surrounded by unusually high walls. The 
Warneford Asylum, near Oxford, is well situated, and 
the grounds are well laid out. Saint Luke's Hospital is 
ill placed, and is extremely deficient in airing-grounds. 
The galleries, however, are very spacious. From the 
curative wards of this Hospital, cases of epilepsy, para- 
lysis, and idiocy, and also cases of more than a year's 
standing are excluded ; but there is a ward appropriated 
to incurables, limited to 100 patients. The Asylum at 
Northampton is well situated : the buildings are well 
arranged ; it has several walled yards, and also extensive 
grounds, in which the patients who can be trusted, take 
exercise, and which, from the circumstance of their being 
bounded by banks and hedges, instead of high walls (as 
is usual in other Asylums) possess a character of great 
cheerfulness. The Bethel Hospital at Norwich, and 
the Asylum at Manchester, from their sites and accom- 
modations, are very ill adapted for receptacles for the 
Insane. 

In some of these Public Hospitals, the Governing Exemption 
Bodies claim, on behalf of their Institutions, an entire ^l"™ ''f}^^^^^ 

' claimed in som< 

exemption from Visitation. We cannot, however, but cases. 
think, that all places receiving and detaining in custody 
any class of Her Majesty's subjects, should be open to 
inspection by proper authority ; and we do not perceive 
anything in the constitution of Hospitals of this nature 
that distinguishes them from other Public Asylums, or 

D 



34 

provides any sufficient security against the chances of 
abuse. 

3. Licensed Houses. 
Licensed The Houses which are licensed for the reception of 

Houses consist x •i^ii?^!. i_-T-j-ii 

of three classes. I"sane persons consist, nrst, ot those which admit only 
Private Patients; secondly, of those which admit both 
Private and Pauper Patients ; and lastly, of the licensed 
parts of Workhouses, which receive Paupers only. 

Our object, in this Report, is to bring before your 
Lordship's especial notice, such instances of existing 
evils in Lunatic Establishments in general as are of mag- 
nitude, and require immediate correction ; leaving such as 
are of less importance, and appear to be in a state of 
progressive amendment, to the effect which a strict inves- 
tigation cannot fail, in the course of time, to produce. 
With this view, we think it expedient, on the present 
occasion, to advert more especially to the character of the 
Licensed Houses which receive Paupers, and which are 
necessarily resorted to on account of the Public Asylums 
being wholly insufficient for that class of Patients. It is 
in these Houses that the principal defects have been found. 
In regard to Licensed Houses which receive Private 
Patients only, although many of them are susceptible of 
improvement, their prosperity is more essentially dependent 
on their good conduct, and they therefore present less 
occasion for animadversion. 

Some of the Establishments, which receive Private 
Patients only, possess every accommodation and conveni- 
ence which comfort, or even luxu)*y, can require ; and in 
them the Patients are generally treated kindly and 
judiciously. We abstain from pointing out specially the 
Houses of this class which we consider to be the best, in 
order that we may not indirectly affect the character of 
others, which, although inferior in accommodation and 
arrangement, are nevertheless well conducted. These 
remarks, it should be observed, apply not only to Houses, 



35 

receiving Private Patients only, which are situated in the 
Metropolitan district, but to some in the Provinces. 
The former have for many years been under our exclu- 
sive jurisdiction, ahd their condition has been frequently 
the subject of former Reports to your Lordship ; and 
although very great improvements have been made in 
many of them, and no important defects in their manage-' 
ment demand particular notice from us at present, we are 
nevertheless convinced that some of these very houses, of 
which we now speak in terms of commendation, would 
soon become the scenes of great abuses, were it not for 
the checks interposed by the constant and watchful visit- 
ation to which they are subjected. 

It is due to the Proprietors of Licensed Houses in the Alterations and 
provincial districts, to state that alterations to a consider- •"pro^ciuents. 
able extent have been already made by several of them, 
upon our suggestions ; that others are in progress ; and 
that, upon the whole, a decided improvement has already 
taken place in some parts of these Establishments, though 
much still remains to be done. There are some of these 
Houses, however, which require to be greatly altered 
before they can be considered as fit receptacles for the 
Insane ; but the Proprietors having expressed a willing- 
ness to make improvements, we shall not call particular 
attention to them on the present occasion. Should our 
expectations of amendment not be realised, we shall think 
it our duty to bring before your Lordship's notice such 
defects as may continue to exist, in our next Report. It 
will be necessary, however, even in our present Report, 
to advert to certain irregularities and partial defects in 
some of these Houses, which ought not to be passed over. 

At the Licensed House of the Rev. Dr. Chevallier, at irregularities at 
A spall Hall, in the county of Suffolk, who is a practising Asi,an*'Hali"''' 
Physician, as well as an officiating Clergyman and acting Suffulk j 
Magistrate of the county, there were at our first visit, in 
1842, three certified Patients, and eight other ladies and 
gentlemen, who were reported to us as not Insane, residing 
D 2 



86 

there as boarders. One of these gentlemen was stated to be 
the Curate of a neighbouring church, and he was therefore 
not examined: it was, however, afterwards ascertained 
that he had been previously confined as Insane. The 
other boarders were examined. One of them was a 
Clergyman who had been previously confined under cer- 
tificates, and was still low-spirited ; another was an im- 
becile young man, not fit to be trusted in society ; a 
third was a lady who was manifestly Insane ; a fourth 
was a gentleman who fancied that he was becoming In- 
sane ; and a fifth was his companion. The remaining 
two boarders were ladies of weak minds and nervous 
habits. 

The Visiting Justices subsequently examined five of 
these boarders, and came to the conclusion that three of 
them were of sound mind, that one was Insane, and that 
the mental condition of the fifth was doubtful. At our 
second visit, we were satisfied that one of the male 
boarders, whose case was considered as doubtful by the 
Justices, was decidedly of unsound mind; and he aftei'- 
wards became so manifestly Insane, that he was removed 
in a hopeless state to another licensed house, as a cer- 
tified Lunatic. This gentleman had been permitted to 
execute some deed or instrument during his residence in 
Dr. Chevallier's House, with his privity and approbation, 
by which some cottages were said to have been leased or 
disposed of. 
At Dr. Allen's, At our first visit to the House of Dr. Allen, at High 
Essex •^^'^ ' Beach, in the county of Essex, in September, 1842, we 
found a gentleman, residing as a boarder without certifi- 
cates, whom we had known as a certified Patient in one of 
the Houses in the Metropolitan district : this person was 
evidently unfit to be at large. Dr. Allen stated that he 
had been in the habit of sometimes receiving low-spirited 
or desponding persons as boarders. He also said that he 
had, on several occasions, permitted patients in his Esta- 
blishment to execute deeds afifecting property, but that 



37 

before doing so he always satisfied himself that the act 
was proper. There are three different houses belonging 
to Dr. Allen at High Beach, which are licensed, and also 
a cottage which is not licensed, but to which patients are 
nevertheless sometimes removed.* These houses, at the 
times of our visiting them, were not in a good state of 
repair. 

At our second visit, in 1843, to the house of Mr. At Mr. Ogil- 
Ogilvie, at Calne, in the County of Wilts, we found that ■yi^-j*'^'^ ' 
he was in the habit of receiving from time to time, a gentle- 
man without certificates, who had been previously confined 
in his House as a Patient. This practice was objected to by * 

us in the Visitor's book, and the Visiting Magistrates, on 
two subsequent occasions, expressed their entire concur- 
rence in our views upon this subject. At our fourth visit 
to this House, in April, 1844, there were three persons, 
who it was said were not Insane, residing in the house as 
boarders. One of these persons was the gentleman who had 
been previously confined under certificates at Mr. Ogilvie's, 
and another was a person who had been a certified Patient 
in two other Houses, and who, if not positively Insane, was 
in a very doubtful state of mind. He had quarrelled with 
his own relations, w^ho are highly respectable, and he ex- 
pressed a desire to be reconciled to them. The person 
and property of this individual both seemed to be under 
the control of a solicitor, and we regretted that he was 
not under the care of the members of his own family. 
Mr. Ogilvie advertises, that he receives Nervous as well 
as Insane Persons in his establishment. 

Houses which are Licensed for the reception of Insane Nervous persons 
Persons, ought to be kept exclusively for that purpose ; received in 

and the reception of nervous, imbecile, and dejected per- Houses licensed^ 

for the Insane, 
sons, amongst those who are Insane, and often dangerous, 

is for obvious reasons open to serious objection. The 

admission of such persons without orders and certificates, 

* This cottage has since been included in the license granted is 
October, 1843. 



38- 



appears, however, to be contrary to law, and is assuredly 
liable to great abuse. The practice is, or may be, made 
a subterfuge for receiving, as nervous, those who are 
manifestly of unsound mind. In the Houses above 
noticed, some of the boarders had been previously in 
confinement as certified Patients; one of them sub- 
sequently became maniacal, and was removed to another 
Licensed House ; and others were manifestly Insane at the 
periods of our visits. The great object of the Laws for 
the regulation of Licensed Houses is, to insure to every 
person confined in them the advantage of being regularly 
♦ visited, and thus to provide a security against improper 

acts, affecting either the person or the property of the 
Insane. Every individual confined under certificates is 
examined by official visitors, whose duty it is to satisfy 
themselves not only that he is properly treated, but that 
he is also a fit person to be detained ; and such investi- 
gation is some protection against persons of unsound 
mind being induced to make dispositions of their pro- 
perty. It is questionable, whether a proprietor of a 
Licensed House who receives boarders of this class, or 
who permits deeds to be executed by persons who are 
under confinement as Patients, ought to be entrusted 
with a License. 
Reasons for We have brought this subject before your Lordship's 

bringina; the . . . , , tj j 

subject forward notice, m a special manner, because Boarders, repre- 
in a special sented to be of sound mind, have been removed from 

manner. 

several Licensed Houses upon our suggestions, whilst at 
the Houses of Aspall Hall and at Calne, the practice of 
receiving them has been persisted in, notwithstanding 
our repeated remonstrances. Your Lordship is aware 
that we formerly prosecuted a person for improperly 
receiving insane persons as Boarders, and procured his 
conviction and imprisonment, and that we have lately 
applied to you for authority to visit Houses in which 
Boarders have been illegally taken, with a view to the 
prosecution of the Proprietors. 



39 

Dr. Finch at Laverstock, in the County of Wilts, Inegnkiitks at 

Dr. Finch's, 

occupies a private residence near to his JLicenaed House, Laveistock 
but entirely separated from it. In this House, although Wilts; 
it is not licensed, he has been in the habit of keeping 
Patients. This practice has been objected to by us as 
irregular, and Dr. Finch stated at our last visit, that the 
Clerk of the Peace thought the objection would be 
done away with by merely inserting in the next 
License the word "Houses" instead of "House." By the 
22nd section of 2 & 3 Will. IV. c. 107, such a License 
would be invalid. Dr. Finch has also another House 
in Salisbury which is not Licensed, but in which he has 
admitted that he sometimes had more than one Patient. 
These practices are irregular and very objectionable. 

The Asylum at Cranbourne, in the County of Dorset, Asylum at 

11 • • 1 . • 1 1 1 • 1 • ^1 Cranbourne, 

has been visited three times. At the third visit, on the Dorset • 
11th of Oct., 1843, the Proprietor was absent thirty 
miles from Cranbourne, having left home on the Tues- 
day, and not being expected to return until Friday. 
There was no Superintendent, Keeper, or Nurse, to 
take charge of the Patients, and there was only one 
female servant, and a boy, sixteen years old, in the 
House. We wgre told that there was a farming man 
who might be sent for, in case any of the Patients should 
be violent. A female who resides in an adjoining House 
comes to the Asylum daily, and presides at meals, and 
assists in the Establishment. There was also a Female 
who had been a Patient, and was still a Boarder in the 
House, who assisted in the management of it. The 
Proprietor of this House has not been at home at any 
one of the visits of the Commissioners. If the engage- 
ments of the Propi-ietor of an Asylum take him so 
frequently, and for long periods, from home, some 
responsible and competent person ought, we think, to 
be left in charge of the Patients, 

At Ringmer, near Lewes, in the County of Sussex, Ringmer, near 
a female is permitted to be almost entirely without ^^^^'^^j Sussex; 



40 



Halstock, 
Dorset ; 



Belle Grove 
House, near 
Newcastle ; 



Led don, 
Norfolk, 



Medical Journal 
often neglected. 



clothing ; and although the Patients seem to be kindly 
treated, the House requires great improvement. At 
Halstock, in the County of Dorset, the Proprietor seems 
kindly disposed towards his Patients; but the rooms 
occupied by two of them have been reported upon 
at our dijfFerent visits as defective in every respect. 
At the last visit, they were described as low, 
dirty, and without any furniture except a wooden 
bedstead. 

At Belle Grove House, near Newcastle, more restraint 
has been found in practice than is met with in well 
conducted Houses, and the Establishment is not in a 
good condition, nor under proper management. The 
beneficial interest in this House appears to have been 
transferred to the gentleman who now has the License, 
either as a Creditor, or as a Trustee for the Creditors of 
the former Proprietor. 

The state of the Licensed House at Loddon (in 
Norfolk) has been reported anything but satisfactory 
or creditable. The apartments in general are small, low, 
and ill-ventilated, and the whole House dilapidated and 
cheerless. One place, which is used by two Male 
Patients as a sitting-room, is very objectionable. In 
this House, little provision appears to be made for the 
comfort or cure of its unfortunate inmates. Although 
the Magistrates who visit it generally make favourable 
Reports upon its condition, it has been found on our 
visits in the condition above described.* 

In many Licensed Houses receiving Private Patients 
only, and in some also receiving Paupers, the Weekly 
Medical Journal, required to be kept by 2 & 3 Wm. IV. 
c. 107, sect. 33, has been altogether neglected. In some 
cases, the Proprietors, being Medical men, have con- 
tended that they are not required to keep such a journal. 



* Very recently, and since this Report was prepared, the House has 
been again visited by two of the Metropolitan Commissioners, who 
state it to be now somewhat improved. 



41 

There is, in our opinion, no ground for this construc- 
tion ; a journal being required to be regularly kept 
in every house, without exception, which is licensed for 
the reception of Insane persons. 

We now proceed to notice those Houses which, 
although they admit private Patients, are more parti- 
cularly devoted to the reception of Paupers. 

Amongst the provincial Houses which are licensed to Provincial 

_, , , , , , ^ T-' • r J Houses licensed 

receive Paupers, the best-conducted are those at tairiord, ^^ receive 

Market Lavington, Devizes, Newcastle (Drs. Smith paupers. 
and Mackintosh), Bensham and Dunston Lodge, near 
Newcastle, at Hull (the Refuge), and at Droitwich. 
The Proprietors of the Houses atFairford, Market 
Lavington, Dunston, and Devizes, occupy farms and 
land, which afford employment for their Paupers : but 
it may be doubted if the Houses at Bensham and New- 
castle, and the Refuge at Hull have sufficient ground for 
the employment of the Patients. The yards be- 
longing to these last-mentioned Establishments, with 
few exceptions, are confined. In some of these Houses 
improvements have been made, and in others, altera- 
tions are in progress, which are quite necessary. The 
alterations at Bensham are very extensive. We have been 
desirous, on the ground of expense, not to press alter- 
ations too hardly upon the Proprietors. The Establish- 
ments at Newcastle and Hull belong to Medical Men. 
The Proprietors of the Houses at Fairford, Market 
Lavington, and Devizes are not Medical Men, but have 
Resident Physicians or Apothecaries. The Diet in all 
these Houses is good, and in some of them very liberal. 

We have observed that Houses which have been for- Asylums for- 
merly private Mansions frequently require extensive houses. 
alterations, to make them fit for Asylums : that the 
Mansion is sometimes engrossed by the Proprietor, his 
family, and a few Private Patients ; and that the Paupers 
are consigned to buildings which were formerly used as 
offices, and out-houses. Of this description are the 



42 

Houses at Lainston, and Nursling, in the County of 
Hants, Bailbrooke, near Bath, Plympton, in the County 
of Devon, Derby, and Duddeston, near Birmingham. 
The House at Duddeston has only one dull Yard for the 
Male, and one, for the Female Paupers ; and at Bail- 
brooke, there was, until very lately, and even after we 
had remonstrated on the subject, only one Yard for the 
alternate use of the Male and Female Paupers ; the 
Males had no day-room, except the confined space in a 
narrow sleeping-gallery, and some of the Paupers still 
sleep in a cellar-like place on the basement story, 
which we consider unfit for such a purpose. These 
Establishments possess the means of affording their 
inmates exercise in their Gardens and Grounds, but we 
have not satisfied ourselves that they are allowed a suf- 
ficient use of them. Although we consider the Houses 
at Bailbrooke and Duddeston, in their present state, to 
be ill-adapted for the care of Pauper Lunatics, we think 
that the Proprietors treat their Patients with kindness. 
System adopted Two Licensed Houses, namely, those at Duddeston 
and Hil^ea in ^^^ Hilsea, deserve particular notice on account of the 
connection with manner in which they have been established and carried 

Workhouses, 

on in connection with Workhouses, which send to them 

only their unmanageable Patients, and afterwards remove 

them when they become tolerably tranquil, without 

reference to the propriety of their remaining at the 

Asylum, for the purpose of cure. 

As>lum at The Asylum at Hook Norton, in the County of 

oT rd hi' °°' Oxford, has lately been taken by a Medical Gentleman, 

who appears disposed to make improvements ; but at 

present some of the Yards are small and dull. 

Fisherton The accommodations for the Paupers at Fisherton 

huTY^' ' ^ '^' House, near Salisbury, require great alteration and 

improvement. The Proprietor has lately purchased some 

land adjoining the House, and states his intention to 

make additions to his premises, which are quite essential. — 

Some of the apartments at the Licensed House at Gates- 



43 

head Fell, near Newcastle, were very defective ; but con- Gateshead Fell, 
siderable improvements have been lately made in them, at ' 

our suggestion. — The House at Gate Helmsley, near Gate Helmsley, 
York, is, in its interior, commodious, and well adapted " ' 

for an Asylum, having been built expressly for the pur- 
pose. The Yards, however, are extremely gloomy and 
confined. The Proprietor is desirous to improve them, 
but there are local difficulties. — The House at Dun- Dunnington, 
nington, near York, is of an inferior description: until ' 

very lately there was only one Airing Court for the 
Males and Females, and the Males were consequently 
locked up during a great part of the day. Some of the 
sleeping-rooms in this house are very bad. 

The parts of the Workhouses at Morda, near Os- AVorkhouscs at 
westry, in the County of Salop, and at Stoke Damerel, ^Jg^oke^"^' 
near Plymouth, which are Licensed for the reception of r)amere], 
Insane persons, are extremely ill-suited for the purpose. 
The Patients at Stoke Damerel are, however, under 
excellent management. — At the Licensed part of the 
House of Industry at Kingsland, near Shrewsbury, Kingsland, near 
containing from eighty to ninety Insane persons, they ^ " y > 

were nearly all fastened to their beds at night by chains 
to the wrists. In consequence of our remonstrances, 
this restraint has been in a great measure discontinued. 
— The Licensed Workhouse at Carisbrooke is much Carisbrooke. 
improved, and has very good accommodation for the 
Patients, and good grounds and Yards for exercise. It has 
never been the practice to detain any curable persons 
at this Workhouse. 

There are four Houses in the Metropolitan District Asylums in 

. . 1 • T« • 11 Metropolitan 

receiving Paupers and private Patients ; namely, the District : 

Asylums atHoxton and Peckham,and the Red and White 

Houses at Bethnal Green, which adjoin each other. The Betlmal Green ; 

one is appropriated to Males and the other to Females. 

The premises comprise about nine acres of land, and 

are in a populous neighbourhood : not more than two 



44 

of these nine acres are used for the out-door employment 
of the Male Paupers. The Houses were, until lately, 
old and inconvenient, and the yards not well arranged. 
Almost the whole of the Buildings, however, are in the 
course of being taken down and rebuilt, and the Esta- 
blishment is undergoing extensive improvements. We 
have visited few, if any, receptacles for the Insane, in 
which the Patients are more kindly or more judiciously 
treated than in these two Houses. The abuses which 
existed in this and some other Asylums, previously to 
the year 1828, led to the introduction of the system of 
Visitation by Commissioners in the Metropolitan district. 
The Houses at Bethna) Green which were amongst the 
worst, now rank with the best receptacles for the Insane. 

Hoxton House; The Asylum at Hoxton is situate in a densely- 
crowded neighbourhood : the Yards are dull and confined, 
and the internal accommodations are inconvenient and 
defective, and it has no land whatever for employing its 

Peckham Paupers.— The Peckham Asylum has great advantages 

"^^' over those at Bethnal Green and Hoxton, in its site and 

grounds, and the internal accommodations are in general 
good. This house, however, has always been a source of 
trouble to us, upon the subject of its diet. It has, on 
several occasions, been specially visited on this account, 
and frequent remonstrances have been made. Applica- 
tion has been lately made for licensing the House for 
the reception of a larger number of Patients. The grant 
of the License, however, has been delayed, until we shall 
be satisfied as to the diet of the Pauper Patients. — It 
may be asked, perhaps, if we have not been too lenient 
in renewing, from time to time, the Licenses for the 
Peckham and Hoxton Asylums. Your Lordship, how- 
ever, must be aware, that in consequence of the deficient 
accommodation in Public Asylums, if Licenses were 
withdrawn from Houses containing large numbers of 
Paupers, there would be no alternative, but to send the 



45 

Patients to Workhouses, or to board with other Paupers, 

where they would not have the care which they now 

receive under regular visitation and supervision. 

Many of the Licensed Houses are the freehold of the Influence of 

Proprietors, and others are held upon lease, and some (.g"gg^ Houses 

only by tenancy from year to year. We notice this o° improve- 

ments involving 
circumstance, as it of course influences the adoption or expense. 

rejection of any improvements that may be suggested 
by us, which involve much expense. 

It is only fair, to state that very important and exten- Improvements 
sive improvements have been already made in several Asylums. 
of the Licensed Houses since the commencement of our 
visits. Additions to the yards, grounds, and buildings 
have been made at the Houses at Gateshead Fell, 
Bensham Asylum and Dunston Lodge, near Newcastle, 
at Bailbrook House, near Bath, at Laverstock, near 
Salisbury, at Carisbrooke, in the Isle of Wight, at 
Belle Yue House, Devizes, and at Fairford • but other 
improvements are still requisite in some of these Estab- 
lishments. In many of the other Houses which we 
have noticed, and in some others which we have not 
remarked upon, some alterations are essential. We have 
found, in a few Houses and Asylums, a practice of per- 
mitting two men to sleep in the same bed, and in 
many Houses and Asylums of allowing only two men 
to sleep in one room. This practice has been discon- 
tinued at the York Asylum, and at Newcastle (Smith 
and Mackintosh's), at Hanwell, and in many other 
instances, upon our suggestion. At Dunston Lodge, 
the practice is still continued, notwithstanding our 
remonstrances ; and it still continues also at the Chester 
Asylum ; although alterations have been lately made 
there, we believe, in some of the rooms (which are 
capable of holding two beds only) at our suggestion. 



46 



Ha vei ford west ; 
Commissioners' 
Report in 1842, 
recited. — Asy- 
lum formerly a 
gaol. 



Number of pa- 
tients in 1842, 



Extreme defi- 
ciency of com- 
fort and con- 
venience. 



6. Abuses and Defects. 

Having thus called your Lordship's attention to the 
Asylums of all classes which have partial defects, it is 
now our duty to bring under your consideration the 
condition of the Asylums and Licensed Houses which 
deserve almost unqualified censure. 

The Asylum at Haverfordwest was first visited by the 
Commissioners on the 13th of September, 1842. Their 
Report states that this Asylum was formerly a small gaol, 
for the criminals of the town, but was (in 1822), by 
virtue of an Act of Parliament, appropriated to the re- 
ception of Lunatics. It did not appear that any addition 
or alteration whatever had been made, so as to adapt it 
to the accommodation of patients. On the contrary, all 
the ^cells and rooms were apparently in their original 
condition, not even windows having been added, except 
in the part which faces the public street. 

The Asylum, at that time, (1842,) contained eighteen 
Patients, nine being Males and nine Females ; and the 
Corporation of Haverfordwest contracted with a person 
to supply the Patients with food and other necessaries. 
The Commissioners felt it their duty to report that 
the Asylum was deficient in every comfort, and almost 
in every convenience; the rooms being small and ill 
ventilated, some of the lower rooms (originally cells 
for Prisoners), being almost dark, and the interior of 
the Asylum altogether out of repair. The two day 
rooms, in which the less violent Patients were confined, 
(one having seven Males and the other five Females), 
each measured about twelve feet by nine feet : the floors 
were of soft stone, but parts of it (in the Female 
ward considerable parts), had been torn up and 
destroyed. There was no seat, or table, or any article of 
furniture in the Women's Room, and nothing, except a 
table, in the Men's Room. The Men were standing; the 



47 

Women standing or sitting on the floor. On the cir- 
cumstance being noticed by the Commissioners, a long 
board or seat was brought into the Men's Room from the 
airing-ground, and fixed against the wall. It was not 
sufficient for the seven Male Patients who were in the 
room to sit on. Four of the Men, however, sat down 
on it ; the others remained standing. In the airing- 
ground belonging to the Women, there was a bench, 
which apparently belonged to their Room. There were 
large holes in some of the walls and ceilings. The 
airing-courts were very small and cheerless, particularly 
that belonging to the Men, and they were both strewn 
with large stones, which had fallen or been forced 
from the Building. There were two mischievous 
Patients, unrestrained, amongst the Men, (in whose 
hands these stones might be formidable weapons,) and 
another fastened in a chair, in a separate room or cell. 

The dress of the Patients was, in almost every Bad state of 
instance, dirty, ragged, and insufficient. One of the ^ ° "^^' 
Female Patients pulled off her shoes and stockings, 
.which were nothing more than rags, such as are 
occasionally seen on heaps of rubbish. The Com- 
missioners were informed that there was not a single 
change of linen (either for the beds or for the person), 
throughout the Asylum. This fact was complained of 
by the Matron. Indeed, the Commissioners could not 
discover any linen whatever, except upon the persons 
of some of the Patients, and the dirty cases of the straw 
beds, throughout the House. There were only sixteen 
single beds for the eighteen Patients confined in the 
Asylum. One Patient (a Boy of nineteen) slept on 
loose straw, on the stone floor, in a small dark cell; and 
one other Patient (a Girl), who was convalescent, 
slept in the same room with the Keeper and his W^ife, 
on a bed belonging to them. She must otherwise 
have slept upon the floor, and apparently without 
bedding. 



48 



Want of bed- 
ding. 



Restraint. 



Want of exer- 
cise and employ- 
ment. 



The Commissioners cause4 many of the beds to be 
uncovered, and found that there were no sheets 
or blankets, and little more than a single rug to cover 
the Patients. In more than one instance, the scrap 
of blanket (allowed in addition to the rug) was insuf- 
ficient to cover half the person. The beds were of 
straw, and almost all of them were inclosed in coarse 
linen cases; but although there were several dirty 
Patients, there was not more than one case for 
each bed. Some of the cases were soiled, and all of 
them appeared dark, as if from long use. The Matron 
stated that she had applied repeatedly for more bed- 
clothes and for linen, but without effect ; the Contractor 
would not send them. She complained to the Commis- 
sioners, that the state of the Asylum (in reference to its 
want of repair, comfort, and accommodation, and the 
destitute condition of the Patients) was dreadful ; and 
she expressed her earnest hope that some person would 
speedily interfere on behalf of " the poor creatures con- 
fined there." 

In regard to restraint, the Commissioners found that 
no belts, hand-locks, or strait-jackets were allowed, 
but the refractory Patients were confined in strong chairs, 
their arms being also fastened to the chair. Two were 
thus confined, separately, in small rooms, into which 
scarcely any light entered through the gratings. One 
was the Boy before mentioned, who slept at night on the 
floor of the same room ; the other was a Woman who was 
entirely naked, on both the days on which the Com- 
missioners visited the Asylum, and without doubt during 
the whole of the intermediate night. Both these were 
dirty Patients. In the Woman's room, the stench was so 
offensive, that it was scarcely possible to remain there. 

During wet weather, there was no place whatever for 
exercise ; and at other times there was not sufiicient 
space for the purpose. No attempt was made to employ 
any of the Patients, and no books or other amusements 



49 

were provided. Prayers were never read, and no Cler- 
gyman ever visited the Asylum, although one of the 
Female Patients, who was occasionally depressed, and 
imag-ined that she had not done her duty to a child who 
had died, appeared especially to require such consolation 
as a Clergyman might afford. 

The Keeper and his Wife (the Matron) appeared well- Allowance to 
disposed towards the Patients, but they were themselves ^f^^ 
scarcely above the rank of Paupers. They were allowed 
the same rations as the Pauper Patients, and a salary of 20^. 
a year, between them. They had no assistant or servant, 
for the purpose of keeping the Asylum or the Patients 
clean, for cooking the food, for baking the bread, or for 
any other purpose connected with the Establishment. 
At our first visit, the Keeper was absent. The Commis- 
sioners were informed that he was at work for some 
person in the neighbourhood. 

The Patients were allowed water only for their Insufficient pro- 
drink; culm and clay for firing; straw (chopped and 
whole) for the beds — of the clean as well as of the dirty. 
The bread was dark and heavy, and was made of barley- 
meal and wheaten flour. The Matron said that the 
yeast allowed was insuflScient, and that the oven was 
out of repair, and that consequently she could not make 
the bread good or wholesome. She had repeatedly 
complained of these things without effect. 

As evidence of the spirit in which this establishment Bad spirit 
was upheld, the Commissioners were informed that a few manaKement. 
years ago a person was directed by Government to exa- 
mine the buildings constituting the Asylum, and that, 
some notice being had of his expected arrival, work- 
men were employed during the whole of the preceding 
night upon the repairs, so that when the Governmen 
Agent visited the building in the morning, he found it 
Undergoing repaii:. These repairs, however, were discon- 
tinued immediately after the Agent left the Asylum, and 



50 



Record of Com- 
missioners' 
opinion in Ma- 
gistrates' book. 



Case of Haver- 
fordwest 
brought before 



have never since been proceeded with. These facts were 
stated to the Commissioners by the Matron. 

As the Commissioners had no opportunity of seeing 
any of the County Magistrates, they thought it advisable 
to make the following entry in the book kept at the 
Asylum, in order that their opinion might be known : — 

" The undersigned Metropolitan Commissioners in 
Lunacy have this day visited this Asylum, which, they 
regret to observe, is deficient in almost every comfort and 
accommodation which a Lunatic Asylum should possess. 
The place imperatively requires repair and enlargement. 
There is a deficiency of bedsteads, of seats, of wearing 
apparel, and a great and most culpable deficiency of Unen 
and bedding. 

" They think it their duty to call the attention of the 
Magistrates of this district to the miserable condition of 
the poor persons confined in this Asylum, and to urge 
their immediate interference in their behalf. 

" They suggest that some employment should be pro- 
vided for the Patients ; that prayers (which are now never 
read) should be read regularly; that means should be 
afforded of dividing the violent from the tranquil Patients; 
and that larger rooms and more extensive airing-grounds 
should be provided. They beg further to suggest that a 
liberal contract for the supply of food and clothes, &c. 
to the Patients, should be entered into and eyiforced upon 
the contractor, who at present appears to be irregular in 
his supplies, and to be disgracefully inattentive to the 
applications which the Commissioners understand have 
been made to him, for the supply of clothes, linen, and 
beds to the Patients. 

" The Medical Superintendent is requested to com- 
municate these observations to the Magistrates of the 
district, and to entreat their attention to them." 

On the 3rd of November, 1842, being the first quar- 
terly meeting of the Metropolitan Commissioners that took 



51 

place after the Asylum of Haverfordwest had been visited, Metropolitan 
the case was brought before the Metropolitan Board, and 
they resolved that the opinion of the Law Officers of the 
Crown should be taken as to " the parties amenable for 
the great and cruel abuses existing in this Asylum." 
They also ordered a copy of the Visiting Commissioners' 
Report to be sent to the Lord Chancellor, and to the 
office of the Secretary of State for the Home Department, 
accompanied by a letter, intimating that the importance 
of the case had induced the Metropolitan Commissioners 
to take the opinion of the Law Officers of the Crown. 
The copies of the Report were accordingly sent, and on Communication 
the 28th of January, 1843, Sir J. Graham acknowledged S^y^orState?" 
the receipt of the letter sent to his office from the Metro- 
politan Board, and enclosed a letter from Mr. Leach, 
Chairman of the Quarter Sessions for the County of 
Pembroke, relative to the care and custody of the Luna- 
tics in the Haverfordwest Asylum. On the 7th of 
February, 1843, Sir J. Graham wrote to the Metro- 
politan Board, requesting to have the opinion of the Law 
Officers of the Crown as to this Asylum, when it should be 
obtained. In the meantime, a case, stating the facts, 
accompanied by a Report of the Visiting Commissioners, 
had been laid before the Attorney and Solicitor-General. 
After some time the opinion of the Attorney- General was 
obtained ; but upon perusing it, it was found necessary to 
call his especial attention to some points arising out of 
the case, and a conference subsequently took place be- 
tween him and the Solicitor-General ; and on the 30th of 
May, 1843, they gave their joint opinion that the " cause Opinion of Law 
of the state of the Asylum appeared to be the neglect and Officers. 
want of attention on the part of the Justices of the Town" 
(of Haverfordwest) : but that it was difficult to say 
that there had been any breach of the provisions of any of 
the Acts of Parliament, which could be the subject of legal 
proceedings. And they concluded by recommending 
"that a strong remonstrance and representation should 
e2 



52 

be made to both the Justices of the Town and of the 
County of Pembroke ;" and by saying, that if the Jus- 
tices of the Town had not made a Code of Regulations 
for the Asylum, they might be compelled to do so, by 
mandamus. 

Second Report At the second visit made to this Asylum, in August, 

of Commission- ,„,„,„ .. ,1.1^ 

ers, in 1843. 1843, the Commissioners reported that some improve- 

Asylum wholly ^^gj^j. y^^^ j^gg^ made, but that the great want of accom- 
unfit for treat- 
ment and care modation in the Asylum, and the very narrow dimensions 
of Insane. ^^ ^^^ ^^^^^^^ almost precluded the possibility of pro- 

viding the Patients with suitable occupations or amuse- 
ments. Occasionally, one or two of the Patients, it 
appeared, were taken out for a walk into the town ; and 
within the precincts of the Asylum, a few of the women 
sometimes assisted a little in the household work. A 
Surgeon, practising in the town, visited the House 
once, and occasionally twice, a week ; but the Commis- 
sioners could not find, from any of the documents;, that 
he made any Reports or Entries relative to the Patients 
or the Asylum. It appeared that the House had then 
lately been visited weekly, by the Mayor or one of the 
Magistrates of the Borough, and sometimes by both, 
accompanied by a Police-Constable. The arrange- 
ments regarding the diet appeared to the Commissioners 
to be on a scale of extreme parsimony ; and they con- 
sidered that although symptoms of some improvement 
were manifest the place was wholly unfit for the treat- 
ment and care of the Insane. 
State of St. The part of the Bristol Workhouse called St. Peter s 

Peter's Hospi- Hospital, set apart for the Pauper Lunatics of the city, 

tal, Bristol. r » f r j ■> 

is without any day-room, eating-room, or kitchen, for the 

Females, distinct from their sleeping apartments ; and 

the only place in which they (40 in number) can take 

exercise is a small passage or paved yard at one end 

of the Hospital. It is part of the road for carts to 

the Workhouse, and measures about thirty-seven feet 

by eighteen, and is, from its pavement and extent 



53 

utterly unfit for an airing-ground. The accommodations 
for the men are somewhat better, but they have only part 
of a paved yard, very little larger than that appropriated 
to the Females. The Workhouse itself is in the centre 
of the City of Bristol, and is totally unfit for an Asylum 
for the Insane. There are no means of classification, of 
exercise, or employment. Praise, however, is due to the 
Medical and other Officers of the house, for the attention 
paid by them to the Patients, considering the means at 
their disposal. There were small wooden closets, or Pens, 
for confining the violent and refractory Patients. Those 
for themen were seven feet long by threefeet three inches 
broad, and about nine feet high, and were warmed by 
pipes, and had a hole in the door, and also a hole in 
the ceiling for ventilation. The Pens for the Women 
were smaller and were not warmed, and were ill-venti- 
lated. The walls of each were of wood, but not padded. 
Formerly, Patients were occasionally kept in those Pens 
during both day and night, but the Pens are now very 
rarely used. The entire body of Lunatics ought to be 
removed to more spacious premises, and to a more 
airy and healthy situation. In addition to the jacket 
and leg-locks, a sort of open mask of leather passing 
round the face, and also round the forehead to the back 
of the head, and fastened by leather straps, was at one 
time placed over the heads of such Patients as were in 
the habit of biting; but this mask (as the Commis- 
sioners understand) has been for some time disused. 

At the Asylum at West Auckland, first visited on the State of Asy. 
5th of December, 1842, there were 13 Males, and 16 ^^^land^* 
Females. Each sex had only one sitting-room, with 
windows that did not admit of any prospect from them, 
and the violent and quiet, and the dirty and clean were 
shut up together. There was only one small walled 
yard, and when the one sex was in it, the other was 
locked up. One of the Male Patients said that they were 
made so tender by their confinement that their health 



54 

was destroyed. There were two small grass closes belong- 
ing to the House, but they appeared to be little used 
for the employment of the Males. In the small, cheer- 
less day-room of the Males, with only one unglazed win- 
dow, five men were restrained, by leg-locks, called hobbles, 
and two were wearing, in addition, iron hand-cuiFs and fet- 
ters from the wrist to the ankle : they were all tranquil. 
The reason assigned for this coercion was, that with- 
out it they would escape. One powerful young man, 
who had broken his fetters, was heavily ironed, and 
another was leg-locked and hand-cuffed, who was under 
medical treatment, and in a weak state. One woman was 
leg-locked by day and chained to her bed at night. Chains 
were fastened to the floors in many places, and to many 
of the bedsteads. The Males throughout the House 
In Commis- slept two in one bed. The Commissioners who first 
unfit for Insane visited the Asylum, stated their opinion to be, that it 
Persons. -^g^^ entirely unfit for the reception of Insane Persons. 

It was also visited on the same day by two Magistrates, 
who entered the following Minute in the Visitor's 
Book :— 

5th December, 1842. 
Report of Visit- " We this day visited the Asylum, and found that 
on^dayofCom- the Commissioners had just left it. We found every 

missioners' first tJjjjj- j^ „qq^ order." 

visit. ® ° 

Three Magistrates, with one Medical Attendant, on 
the 24th January, 1843, entered the following Minute 
in the Visitor's Book : — 

2ith January, 1843. 

" Visited this House and found everything in proper 
order, and the House in a clean state." 

Second visit of On the 16th of May 1843, two other Metropolitan 

to^WesTAuck- Commissioners visited this house and found the Patients 

^'"^*^' all locked up in their day-rooms, with the exception of 

two or three who were employed about the House ; the 

restraint had been removed from all the Patients but 



55 

one, without accident or inconvenience of any kind, but 
the House was in the same state in which it was at the 
previous visit. The Patients were listless, without amuse- 
ment, occupation, or exercise. The Medical Attendant 
considered that "bleedings, blisters, and setons" were the 
principal resources of Medicine for relieving- Maniacal 
Excitement. The Asylum was visited a third time by 
different Commissioners, on the 27th day of August, Commissioners' 
1843; and lastly, on the 19th of April, 1844; and the ^^^f/"** ^*'"'''' 
several Commissioners, on both occasions, reported that, 
notwithstanding some alterations and slight improve- 
ments made in consequence of their suggestions, they 
concurred entirely in the opinions repeatedly expressed 
by the other Metropolitan Commissioners, as to the 
total unfitness of these premises for a Lunatic Asylum. 

At the Wreckenton Asylum near Gateshead, first State of Wreck- 
visited on the 2nd of December, 1842, the day rooms, neaJ°GttS3. 
of which there are three on the Male side, and the same 
number on the Female, were confined and gloomy. 
Chains were attached to the floor in several places, and 
it was the practice to chain Patients by the leg, upon 
their first admission, in order, as it was said, to see 
what they would do. In a small dirty room or cell, on the 
Male side, in which a Patient was placed at night, was 
observed a heavy chain attached to the wall, by which 
it was admitted that a Man had been confined within 
the last twelve months. The bedding was in a filthy 
state, and the cell very offensive, as were also most of 
the sleeping-rooms and beds throughout the house. The 
whole place was in bad order ; and the Male Patients 
especially presented a ragged and uncleanly appearance 
and were listless and unemployed. The Females were 
in a better state, in regard to clothing, and some of them 
were employed in needle-work. An old Woman, who 
had attempted to commit suicide, was, at the time of our 
visit, on that account chained by the leg to the fire- 
guard, and she was stated to be usually fastened in a 



56 

similar manner to her bed at night. This place was 
visited again the next day, when the benefit of our en- 
quiries was manifest ; the whole bouse having apparently- 
been cleaned in the meantime, and fresh linen placed 
upon the beds. The Commissioners considered the 
premises in their then state unfit for an Asylum. The 
Commissioners' second visit to this Asylum was made on the 17th of 
May, 1843, by two other Commissioners, and although 
some improvements had been effected, and others were 
in progress, they considered that the place was still not 
a proper Receptacle for Lunatics. At the third visit, 
in August, 1843, the place was clean, and the Patients 
tolerably comfortable : at the last visit, in 1844, the 
Commissioners considered that, although considerably 
enlarged and improved, it was, in many respects, still 
unfit for an Asylum. 

State of At the Licensed House at Derby, first visited on the 

Licensed House r r>. t in • i -r. i 

at Derby. 21st of October, 1842, the straw in the Paupers beds 

was found filthy, and some of the bedding was in a dis- 
gusting condition from running sores, and was of the worst 
materials, and insuflScient. Two Cells, in which three sick 
epileptic Paupers slept, were damp, unhealthy, and unfit 
for habitation. The beds of some of the Private 
Nearly all the Patients were in an equally bad state. Nearly all the 
Jaw violated. provisions of the Law for the regulation of Licensed 
Asylums were violated. A lady was found confined in 
Case of a this House, who was represented to be a Visitor, and not 

sented to be a ^ Patient, but who, upon investigation, was proved to 
Tisitor. have been brought to this House from another Lunatic 

Asylum, where she was a certified Patient. Her name 
was entered, in the Private Account Book of the Proprie- 
tor, as a Patient, and he had given a Certificate that she 
was confined in his Asylum, for the purpose of author- 
ising her Trustee to pay over to her husband dividends 
to which she was entitled, only a few days previously to 
the visit of the Commissioners. The Magistrates of 
the Borough, who are its Visiting Justices, had not 



57 

visited the House for the space of a year, minus eight 
days. This lady had been, during- the whole of her resi- 
dence in this place, from the month of May until Octo- 
ber, anxious to see some Magistrate, with a view to 
demand her liberty. She was afterwards liberated upon 
our remonstrances. This Asylum was found in a better Commissionere' 
state at the second visit, but when visited for a third 
time, on the 18th of October, 1843, it was again in a 
very bad state. The Paupers were still occupying what 
had been the coach-house and stables. The Cells, which 
had been objected to, were not used, but the male Pau- 
pers (fifteen in number) were sleeping in the upper floor 
or loft. One room, measuring seventeen feet long by 
nine in width, had four beds, two rooms had two beds 
each, and there were four single rooms, only six feet six 
inches by six feet. Three beds were placed in the com- 
mon passage. The rooms were low, comfortless, and ill 
ventilated. An Epileptic was in bed in a dying state, 
and the windows and door of his room being closed, and 
there being no opening or other means of producing a 
free circulation of air, the apartment was most offensive. 
Some sawdust had been thrown upon the floor to absorb 
the urine, but nothing had been done to purify the air, 
— ^This Asylum has lately been transferred to another 
Proprietor. 

The Asylum at Lainston, in the County of Hants, State of Asylum 
was first visited on the 14th of October, 1842. The Hants, ' 
Buildings appropriated to the Paupers consisted of 
stabling and out-houses converted to that purpose, and 
were quite unfit to be used as an Asylum. At the 
second visit, these evils were so manifest, that the Commissioners' 
Visiting Commissioners expressed a hope that means ^^'^^^ ^^''* 
would be found to put an end to them, either by refus- 
ing the license, or otherwise. At the third visit, on Commissioners' 
the 22nd of August, 1843, the house was found altoge- 
ther in a bad state. The rooms on the ground-floor, 
both for the Males and Females, were in an extremely 



58 

filthy condition. Seven Female Paupers were restrained 

with iron hand-locks and chains, and strait-waistcoats ; 

and the same seven Women, and three others, were 

chained to their beds at night. We expressed our 

Use of hand- strong disapprobation at the use of hand-locks and 

chains, chains, but the Proprietor said that he employed them 

because they were essential to safety. Previously 

to the third visit, this house had been several times 

visited by the Magistrates. They had entered in 

Magistrates' re- the Visitor's Book, at one visit, a remark, that the 

marks in Visit- 

or's book. sleeping-rooms for the dirty Male Patients, and for the 

Females on the ground-floor, were " unwholesome and 
damp ;" and that the clothing of one of the Patients 
was scanty and insufficient ; at another visit, that the 
yards of the Females were wet and filthy ; and, at 
a third visit, that there was no classification, and that 
their previous recommendations upon this head were 
unattended to. The Paupers in this House are toler- 
ably well-fed, but have been always found dirty and ill 
Commissioners' clothed. It was visited again in April, 1844, and was 
still in so indifferent a state, that the Commissioners again 
repeated their opinion as to the urgent necessity of erect- 
ing a Public Asylum for the county. 
State of House With regard to the house at Nursling, in the same 
Hants. County, the Commissioners, who first visited it on the 

12th of October, 1842, reported that the Buildings ap- 
propriated to the Paupers had been offices, and were in 
a dilapidated state. Their construction was bad, and they 
could not, in the Comnaissioners opinion, be made comfort- 
able. The rooms were small and close, and the airing- 
Commissioners' courts extremely limited in point of space. The Commis- 
sioners who next visited this Asylum, on the 25th 
day of June, 1843, made a similar Report, and objected 
that the main part of the house, as at Lainston, 
was reserved for the Private Patients and the family of 
the Proprietor, and that the out-buildings were set apart 
for the purpose of receiving Insane Paupers, without 



59 

much consideration as to their general comfort or even- 
tual cure. At the third visit, on the 24th August, 1843, Commissioners' 
a similar Report was made, and the bed-rooms for the 
dirty classes, both of the Male and Female Paupers, 
were offensive and confined, and had unglazed windows, 
and only wooden shutters, as a protection against the 
outer air. 

Kingsdown House, at Box, near Bath, was first State of Kings- 

. down House, 

visited in September, 1842. Amongst its great defects, Box, near Bath, 
is the want of airing-grounds. The space allowed for 
exercise, considering the number of Patients, is wholly 
insufficient. One of the wards, in which were fifty 
Female Paupers, had only a very small yard attached to 
it, and' this, being on an abrupt descent and uneven 
throughout, was not only unfit for exercise, but was 
insufficient for half the number of Patients ; and they 
were consequently congregated in a small room at one 
extremity of the yard. Every seat there was occupied, 
and the room itself being ill- ventilated, there existed an 
offensive odour that must have been detrimental to the 
bodily health of the Patients. The airing courts for the 
Females is surrounded by very high walls, and is dull and 
cheerless, and the only yard for the Male Paupers is but 
little better. At the second visit, on the 18th of April, Commissioners* 
1843, the straw-rooms for both sexes on the ground floor, ^^'^^^ ''^' * 
were pointed out by the Commissioners as unfit for use. 
There being only one day-room and one airing court for 
each sex, the noisy, violent, refractory, dirty, and 
dangerous Patients, were crowded together in the same 
small space with those who were clean, convalescent and 
quiet, and the noise and confusion were extreme. There 
were seven Females under restraint; two had strait-waist- 
coats, two had their arms fixed in iron frames, not allowing 
the freedom of hand-locks, and three had iron leg-locks; 
one Female was chained by her legs to a wooden seat in 
a paved passage, to prevent her, as it was stated, hurting 
herself in her fits. Eight or ten of the Females were 



60 

fastened by straps and chains to their beds at night. 
One Male was chained by his leg to a seat in the yard, 
and another Male was chained to his bed at night. At 
Commissioaers' our last visit, on the 24th of April, 1844, a trifling 
enlargement had been made in the yards, one of which 
was covered with macadamized stones, but the House 
was in the same unsatisfactory state, and the same 
harsh and cruel system of restraint was in practice. 
State of Asylum The Asylum at Plympton, in Devonshire, was first 
Devon!^^ °^' visited in October, 1842, when ten persons were found 
under restraint. One of them had been restrained for 
two months, merely for breaking windows. From the 
Complaints of Reports of the Visiting Justices, it appeared that com- 
unattended to^'^ plaints had been repeatedly made of the state of the 
Buildings, but apparently without any beneficial results, 
as they were then in a very objectionable condition. 
One room, in which seventeen Patients lived during the 
day, measured only sixteen feet six inches by twelve feet. 
There was no table in it, and there was sitting-room for 
no more than ten Patients. Several of the bed-rooms 
were cheerless and wet, from the damp or rain, and the 
walls were besmeared with filth. Close to some small crib- 
rooms, in which some Girls (violent patients) slept, there 
was a bed-room for a Male Patient, who, it appeared, 
had access to the room in which the Girls slept. At the 
Commissioners' second visit, on the 14th of July 1843, the condition 
visi . ^£ ^j^g Pauper Patients continued wretched in the ex- 
treme. Some of the buildings, to which attention 
had been directed by the previous Report, were in 
the same objectionable state as then described; the 
day-room being most offensive, and the airing-court 
■comfortless, and rendered dangerous by a quantity of 
loose stones scattered about. In a day-room, in a state 
of furious mania, was a young woman, who had been 
delivered of a child five or six weeks previously, con- 
fined by a strait-waistcoat, and chained by the arm and 
leg to a bench. Another Woman in this ward, in a strait- 



61 

waistcoat, was lying in a hole in the middle of the airing 
court, without covering to her head, or anything to 
shelter her from the broiling sun. Ten Curable Patients 
and two Idiots were under the charge of a Lunatic, who 
was himself confined by a chain from the wrist to the 
ankle, at the arrival of the Commissioners, principally 
to prevent him escaping: this chain was soon afterwards 
taken off at his own request, in order that he might not 
be seen, by the Commissioners, so restrained. The day- 
room of this ward was extremely small, with an unglazed 
window and no table. A series of sleeping cells for dirty 
Patients, connected with this yard, were dark, damp, and 
offensive : they were occupied at night by four Males, 
two in one cell, and two in single cells. The dirty Male 
Paupers slept in a room, formerly the dairy, in which 
were six beds ; it was damp, ill ventilated, and offensive. 
There was only one small window unglazed, which was 
closed with a shutter at night. There were chains and 
wrist-locks attached to nine of the beds on the Male 
sidcj which were constantly used at night, partly to pre- 
vent violence, and partly to guard against escape. Four 
of the Female Paupers, represented to be subject to vio- 
lent paroxysms after epilepsy, were ordinarily confined 
to their beds by chains and wrist-locks. 

At the third visit to this House, on Oct. 2, 1843, Commissioners 
three Women were found chained by their legs to the * 

benches. One of them, mentioned in the previous 
Report, had, besides the chain to her leg, another chain 
passing round her waist, to which were fixed, by an iron 
ring, two hand-locks in which both her hands were con- 
fined. Besides this restraint, there were twenty-one 
Patients who were chained to their beds at night : two of 
these were Private Patients, and the others were Male 
and Female Paupers. The three sleeping-rooms in the 
Women's cottage, could not, in the judgment of the Com- 
missioners, have been cleaned for some days : the wooden 
cribs were filthy, the floor was in holes, and soaked with 



62 

urine, and in parts covered with straw, and excrement. 

We can give no other general description of it, than that 

it was most disgusting and offensive. In a crib, in one of 

these wretched places, a Female Private Patient who was 

cleanly, had been compelled to sleep : she implored us 

only to remove her to a better part of the House. The 

remainder of the third Report of this House by the 

Commissioners, is a detail of numerous other abuses. 

Extract from The following is an extract from it : — '' In one of the 

tWrd're^rt' on " ^^^'^ ^^ *^® Upper Court for the Women, the diraen- 

Asylum at « sions of which were eight feet by four, and in which 

Plympton. 

" there was no table, and only two wooden seats, fast- 
" ened to the wall, we found three Females confined. 
** There was no glazing to the window, and the floor of 
** this place was perfectly wet with urine. The two dark 
" cells, which adjoin the cell used for a day-room, are 
" the sleeping-places for these three unfortunate beings. 
*' Two of them sleep in two cribs in one cell. The floor 
" in the cell with the two cribs, was actually reeking 
" wet with urine, and covered with straw and filth, and 
" one crib had a piece of old carpet by way of bedding, 
" besides the straw, but the other appeared to have had 
" nothing but straw without any other bedding. In 
" the other cell, the Patient who slept in it had broken 
" her crib to pieces, and a part of it was remaining in the 
" cell, but the straw was heaped up in one corner, and 
*' as far as we could rely upon what was said, she had 
" slept upon the straw, upon the ground, at least one 
" night. The straw itself was most filthy, the floor was 
" perfectly wet with urine, and part of the straw had 
" been stuck to the wall in patches with excrement. It 
" must be added that these two cells, and one other 
" adjoining to it, have no window, and no place for 
" light, or air, except a grate over the doors, which 
" open into a passage. The persons of these three 
" unfortunate Women were extremely dirty, and the 
" condition in which we found them and their cells 



63 

*' was truly sickening- and shocking. Adjoining to the 
" two sleeping-cells of these Women, and opening into 
" the same passage, was a third cell which was occupied 
'• as a sleeping-place by a Male criminal of very dan- 
" g-erous habits, and an Idiotic Boy. This cell was 
" dirty and offensive, and the floor of it wet with urine, 
" but it was not in so filthy a state as the other two. 
" The criminal was fastened at night to his bed with a 
*' chain. We strongly objected to these Men being- con- 
" fined in a cell closely adjoining- to the females. The 
" whole of these cells were as damp and dark as an 
" underground cellar, and were in such a foul and dis- 
" gusting- state, that it was scarcely possible to endure 
" the offensive smelL We sent for a candle and lan- 
" tern to enable us to examine them." 

So far from any good having- resulted from the pre- Comments on 
vious remonstrances of the Commissioners, the House condition of the 
was found, at this third visit, even in a worse condition ^°"^®' 
than at the previous visits. The visiting Commis- 
sioners stated, that in their opinion, it was highly dis- 
graceful to the Proprietor to keep his Paupers in the 
wretched condition in which they found them, and that 
his conduct in this respect loudly called for some prompt 
and effective interposition. This Proprietor received 
10*. 6c?. per week for each Pauper, besides a guinea 
upon admission. The Magistrates, who appear to 
have formerly attempted to improve this House, had 
not at our third visit inspected it since the last pre- 
ceding visit of the Commissioners, and on the 2nd of 
October, 1843, it seemed to have been visited only once 
by the Magistrates since the 14th of October, 1842 ; 
namely, on the 14th of June, 1843. We are decidedly 
of opinion, that a person who keeps his Patients in the 
disgraceful condition in which the Paupers tyere found 
in this Asylum, ought not to be entrusted with the care 
of Insane Persons. 

The Asylum at Nunkeeling, near Beverley, in the State of Asy- 



64 



lum at Nun- 
keeling, near 
Beverley, 
Yorkshire. 

Commissioners' 
second visit. 



Discovery of 
six concealed 
sleeping places 
on third visit 
to West Mai- 
ling, Kent. 



county of York, first visited on the 10th of Sep- 
tember, 1842, was found in an indifferent condition, 
but the Proprietor promised to remedy the defects 
objected to. At the second visit in 1843, uo alterations 
had been made. The sitting-room and chambers 
in which the Pauper Patients were lodged, and 
the yards, the only places out of doors to which 
they had access, were extremely small and cheerless. 
Seven Females were confined in a room about twelve 
feet square, where there was no furniture of any kind, 
except one seat not large enough to accommodate more 
than four persons, so that the rest were obliged to stand 
or to sit on the brick floor. Some of the bed-rooms, 
which had been before objected to, were dark, small, and 
off"ensive. In one bed-room for females, the windows 
had been all broken for three weeks, and in a sleeping- 
room on the ground-floor was a woman, a dirty Patient, 
curled up in her bed, which was wet and filthy, and con- 
sisted of chaff and some rags, and she herself was in a 
wretched condition. This House requires very great 
improvement, to render it fit for the reception of Insane 
Persons. 

On the third visit of the Commissioners to the Asy- 
lum at West Mailing, in Kent, on the 2nd of Septem- 
ber, 1843, they were much astonished at discovering six 
sleeping-places for Males in an outhouse, at the upper 
end of the Male Paupers' yard. These places had not 
been laid down in the plan of the House, and they had 
never been shown either to the Visiting Justices, or to 
the Metropolitan Commissioners, who had previously 
visited the Asylum. They were wooden closets, six 
feet long, six feet high, and three feet two inches 
wide ; three being on each side of a passage, which 
was between two and three feet wide. These places 
had a raised floor, upon which the bedding was placed. 
They were all extremely close, but the two centre ones 
had no means of ventilation. They had been regularly 



65 

used, and were occupied by five Males ou the night before 
they were discovered, and were made up for use when 
first seen. They were, of course, quite unfit for sleep- 
ing-places.* 

— Having thus detailed the particulars of some of the Endeavours of 

Commissioners 

more flagrant abuses which have come under our obser- to remove 
vation, we think it right to state to your Lordship that ^"^^^^ ' 
we have made various endeavours to procure their correc- 
tion and removal. We have before stated what steps 
were taken with respect to the Asylum at Haverfordwest, ^t Haverford- 
As regards the Hospital of St. Peter's, at Bristol, we '^^f' ^^ 
received a communication, through Secretary Sir James 
Graham from the Visiting Justices, immediately after our 
first visit to it. In consequence of that communication, 
we made a second visit to the Hospital, and upon a pro- 
posal being made by the Magistrates of Bristol to enlarge 
the present premises for the purpose of an Asylum, we 
reported that, in our judgment, such a measure was 
highly inexpedient. 

Although a new County Lunatic Asylum was in pro- at Plympton ; 
gress for the County of Devon, we felt that the condition 
of the Paupers at Plympton called for some prompt 
interposition, and we therefore addressed a letter to the 
Chairman of the Quarter Sessions for the County of 
Devon, on the 10th of August, 1843, after our second 
visit, calling bis attention to the state of the House. 
No answer had been received to this letter at the period 
of our third visit, on the 2nd of October, 1843, when 
the House was found in even a worse state than at the 
second visit. Subsequently to our third visit, a letter 
upon the subject was addressed by Lord Ashley, as 
Chairman of this Board, to the Earl of Devon, who 
thereupon took immediate steps with a view to remedy 
the abuses complained of. 

* These closets have since been pulled down and the building 
shut up. 

P 



66 



at West Auck- 
land and 
Wreckentou ; 



at Derby ; The Paupers who were confined in the Licensed 

House at Derby having been nearly all sent thither 
by the Magistrates of the County, we addressed a let- 
ter to the Chairman of the Quarter Sessions at Derby, 
on the 10th of November, 1842, bringing the state of 
the Paupers in that House under his notice. We received 
an acknowledgment of the receipt of our letter on the 
1st of March, 1843, but no further communication. 
We wrote at the same time to the Magistrates of 
the Borough, and received an immediate answer. The 
Paupers, however, on our third visit to this House, 
were found in the condition which we have above 
described. 

A letter was written to the Chairman of the Quarter 
Sessions of the County of Durham, on the 15th of Feb- 
ruary, 1843, accompanied with extracts from our Reports, 
and we submitted to the Magistrates whether it would be 
expedient to renew the Licenses of the Houses at West 
Auckland and W^reckenton, without requiring effec- 
tual alterations to be made in them, and security 
for their better management in future. No answer 
has been received to this letter. The House at 
Wreckenton is considerably improved ; but that at 
West Auckland remained nearly in the state which 
we have above described, when visited, on the 19th of 
April, 1844. 

The Commissioners who first visited the Licensed 
Houses at Lainston, Nursling, and Hilsea, in the County 
of Hants, in October, 1842, called the attention of the 
Visiting Justices to the urgent want of a Public Lunatic 
Asylum for the Paupers of the County. The Justices 
at Lainston; ^}xo have visited the House at Lainston since our first 
visit, have, in the Visitor's Book, condemned in unqua- 
lified terms the management of that large Asylum. 
Nevertheless, the Commissioners who visited this place 
in April, 1844, found no material improvement, and 



67 

could only earnestly repeat their call upon the Magis- 
trates of the County of Hants to provide a proper recep- 
tacle for their neglected Paupers. 

In reference to the Licensed House at Box, near at Box ; 
Bath, in the County of Wilts, we have repeatedly pointed 
out to the Visiting Justices the very reprehensible state 
of its yards, and the harsh and cruel system of restraint 
which is there practised. The Visiting Justices con- 
curred in our views, but the same defects as before were 
in existence in April, 1844. We have called atten- 
tion to the unfitness of the Licensed House at 
Bailbrook, near Bath, in the County of Somerset, in at Bailbiook ; 
its present state, for the care of Pauper Lunatics ; and we 
have made similar remarks as to the Licensed House at 
Duddeston, in the County of Warwick. We have also, at Duddeston ; 
in various other instances, made such remarks, in the 
Visitor's Books at the different Licensed Houses, as at other houses. 
seemed to us calculated to excite the attention of the 
Magistrates, to the condition of Houses requiring 
alterations and improvements. 
— By the Act 2 & 3 Will. IV. c. 107, it is directed that visitation of 

three Justices, together with a medical attendant, shall Asylums m 

' " Borough towns. 

be appointed, at the General Quarter Sessions, to visit 
all licensed Lunatic Asylums throughout England and 
Wales, (except those in the Metropolitan district), three 
times in every year. This power, or duty, so far as 
respects the visitation of certain Asylums situate within 
the limits of borough-towns, is now, by virtue of the 
Municipal Corporations Act, exercised by the Magis- 
trates of those boroughs. 

The country is much indebted to the County and Services ren- 
Borough Magistrates for their services, under these acts, ^^^ Borou T'^' 
in all cases where their visitations have been carefully Magistrates. 
and regularly made ; and we are desirous of bearing 
testimony to the solicitude which they have, in many 
instances, evinced to perform a very painful duty. 

It is not our intention to enter into any minute 
f2 



68 

Irregularity in examination of these visits, witli a view of testing their 
Stes.^^ ^^^''" efficiency, in particular districts ; but we feel bound to 
state certain facts which have come under our notice, 
and to offer a few remarks, in order to bring the subject 
of these provincial visits fairly under your Lordship's 
consideration ; the value of which must depend upon 
their frequency, upon their being made without notice, 
and at uncertain intervals ; upon the minuteness of the 
investigations that take place ; and, above all, upon the 
firmness with which the visitors enforce the provisions 
of the Acts of Parliament. 
Oiiltnn, near The Licensed House at Oulton, near Stone, in 

Stone, Stafford. Staffordshire, had not (in October 1843), been visited 
by any magistrate for the space of two years and a 
half. It is right to state, however, that the Medical 
officer appointed to attend the magistrates had himself 
visited this Asylum frequently during that period. The 
Shillingthorpe, Asylum of ShiUiugthorpe, in the county of Lincoln, 
mcoln. (which, however, is in excellent order, and so far 

excuses the neglect of its visitors), is inspected by the 
Magistrates once a year only, instead of three times a 
Great Winston, year. — After our visit to Great Wigston Asylum, near 
Leicestershire. Leicester, (in October 1843) we found that the magis- 
trates had visited it only once during the preceding 
Visits to twelve months. On visiting Heigham Hall Asylum, in 

Heigham Hall, ^^^ couuty of Norfolk, (in August, 1843,) we found 

Norfolk, com- -^ ^ & ' '^ 

paratively use- that the Magistrates visited the place regularly, but that 
their inspection was rendered comparatively useless, 
by their always sending beforehand for the visitors' 
book, which gave the proprietors notice of their intended 
visits. The visitations of Magistrates to the Asylum at 
West Auckland have been already adverted to. 

M^strates' Having felt it our duty thus plainly to express our 

visits, m many opinion of the neglect, in some few instances, of the Visit- 

mstances, regu- _ o ? :> 

lar, and made ing Magistrates, we have the satisfaction of stating that, 

in many instances, the visits of the Magistrates have 

been regular, and that their inspection of the Asylums, 



69 

and their investigation as to the comforts and general 
treatment of the lunatics, have been made with much 
care; with evident solicitude to perform the duties 
imposed upon them ; and with that benefit to the patients 
which must necessarily arise from gentlemen of station 
and local influence giving up their time and attention 
to this subject. 

It has however rarely happened that all the points Magistrates 
to which we have thought it our duty to direct our Jo'alHbir'^^ 
inquiries, have entered into the consideration of thfe county points to -which 
Magistrates. They appear, generally, to have limited ^i^ect their 
their attention to the number, cleanliness, and bodily inquiries. 
condition of the patients confined, and to the ventila- 
tion and general fitness of the wards appropriated to 
their use. And these, without doubt, are subjects of 
great importance to the comforts, and in some degree 
to the recovery, of persons afflicted with insanity. 
Nevertheless, there are other subjects equally deserv- Points usually 
ing of inquiry, to which we do not, generally speaking, °^^ ^'^^^ ' 
observe that the attention of the visiting justices has 
extended. The first and most material of these 
is the state of mind of the lunatic, in reference to 
his fitness for liberation. Secondly, the nature and 
ejBect of the employments provided for the patients, 
with a view of diverting their disease. Thirdly, the 
character of the medical reports, as indicative of the 
care and intelligence bestowed upon the mental condi- 
tion of the patients, by the medical officer; and, 
fourthly, the food (both as to quality and quantity) 
afforded to the pauper patients, the rates of payment 
made for them, and the attention bestowed on them by 
their parish officers. 

In the more careful reports of the Magistrates, some of Remarks on 
these subjects are occasionally adverted to, but in others repOTts. 
both these and other points remain unnoticed. In a great 
proportion of cases, the reports are couched in general 
terms, expressive of the satisfaction of the Visitors at the 
condition of the Asylum, without indicating any particu- 



70 

laf matter as deserving of notice. This species of report, 
although it may be less objectionable in cases where 
Asylums are appropriated exclusively to the reception of 
private patients of the wealthier classes; yet in esta- 
blishments which receive paupers and persons but little 
above the rank of paupers, we have ourselves almost 
always remarked some defect, or have suggested some 
obvious improvement, in reference to the condition of the 
place or of the patients ; and upon these occasions, we 
have thought it right to make ri special statement to that 
effect, in our entry, in the visitor's book, with a view 
to future amendment ; and we have the satisfaction of 
adding that these suggestions have, in many instances, 
met with attention from the Visiting Magistrates. Not- 
withstanding the influence, however, of these gentlemen, 
and notwithstanding such improvements as those to which 
we have alluded and many others, it must, we think, 
be apparent from the state of the Asylums and Licensed 
Houses at Haverfordwest, St. Peter's, West Auckland, 
Wreckenton, Plympton, Derby, Lainston, Nursling, 
Loddon, Aspall Hall, High Beach, Calne, Box, Bail- 
brook, and others, that the visits of Magistrates have 
not had the effect of correcting the irregularities and 
the abuses existing in many of these Establishments, or 
in putting an end, in some few instances, to cruelties of 
a very flagrant character. Much, indeed, remains to 
be done, in order to render many of the existing Asylums 
proper and sufiicient receptacles for the Insane. 
Additional Amongst other means of insuring good conduct in 

cau ion neces- ^j^^ manaeement of Asylums, it has occurred to us that 

sary in granting ° •< ' 

Licenses. some additional caution might be observed in the grant of 

Licenses. Your Lordship is aware that Licenses in the 

Metropolitan district are granted by us, and we are 

careful that the Reports of the different Houses should 

be brought under the consideration of the Board, before 

Commissioners' each renewal. We cannot, therefore, finish our remarks 

granting' upon the performance of the duties assigned by law to 

Licenses recom- the county Magistrates, without recommending that they 



71 

should follow the same course in renewing the Licenses mended to Ma- 
of the provincial Houses. We are of opinion that the ^'^ '^ ^^ 
proprietor of a Lunatic Asylum should always attend at 
the Quarter Sessions when an original or renewed License 
is applied for, with a view of answering such questions 
as may be put to him ; and that the reports of the Visit- 
ing Magistrates, and of the members of this Board, rela- 
tive to the state of his House, should be then read. We 
could further suggest, that in the advertisements usually 
inserted in the county papers, announcing the business pro- 
posed to be done at each sessions, special notice should be 
entered of the intention of parties to apply for Licenses. 
This is already done in Hertfordshire, and we believe in 
a few other counties.* It is also essential, previously to 

* On our first visit to the Retreat near York, we were accompanied 
by Mr. Tuke, a gentleman well acquainted with the management of 
most of the principal Lunatic Asylums, and who has for many years 
made the treatment of Lunacy the subject of his especial observation, 
and he called our attention to the necessity of a more frequent and 
vigorous supervision of all Asylums. As he has already expressed his 
sentiments on this subject, in a publication relating to Hospitals for 
the Insane, we have thought it right to lay them before your Lordship. 

" The appointment of visitors at the Quarter Sessions, to these 
places, may afford a little check against abuse, and some facility for the 
investigation of complaints ; but I do not hesitate to say, that it is a 
most imperfect and unsatisfactory system of visitation, and so I know 
it is felt and acknowledged to be by some who act under the appoint- 
ment, A physician is appointed at the Sessions in conjunction with 
three magistrates, to visit the private houses four [three] times in the 
year. The magistrates will, of course, be much influenced in their 
judgment by theii' medical companion, and thus he is often called upon 
to judge the conduct of his professional neighbours, who may be either 
his rivals or his particular fiiends. It is no imputation on the honour 
of any man to say, that it is not for the public good that he should be 
placed in such a position." — " We shall not, I apprehend, secure 
efficient visitation, until we have an appointment of a number of com- 
petent persons to visit, under the authority of Government, all the 
places of whatever description, private or public, chartered or unchar- 
tered, in which the insane are confined ; to compare the degrees of 
human misery in these abodes, — to ascertain how it may he most 
effectually provided for and alleviated, — to collect information under 
uniform heads from Jail these institutions, — and to report annually to 
the public the results of their observations and inquiries." — Intro- 
duction to " Jacobi's Treatise on Hosipitals for the Insane.'' 



12 

granting a License, to ascertain the fitness and security 

of the premises. 

Escapes from We have made inquiries upon the subject of escapes 

Houses. ffom Licensed Houses, returns of which are require4. to 

be made to our Board, and have not found in general 

much cause of complaint upon this head. Some cases, 

however, have occurred which call for animadversion, 

and some matters relating to the safe custody of certain 

classes of Insane Persons, demand notice at our hands. 

Penaltyimposed The Act 9 Geo. IV. c. 40, has imposed a penalty 

c, 40, on offi- Upon Officers and Servants of County Asylums who 

cers, &c. of permit escapes through neglect or connivance. There 

lums permitting is no similar provision with respect to the Servants of 

on officers &c'. Licensed Houses, although it would seem that the safety 

of Licensed of the Insane, and of the Public, and also of the Pro- 
Houaes. 

prietors of Licensed Houses, equally calls for legislative 

protection. In the course of last summer, a Servant at 

a Licensed House assisted a Lady, who was a Patient^ 

Dang;er of per- to escape. Escapes are not only to be guarded against 
mitting escapes. r , i i , r • • •, 

on account ot the hazard to others ol permittmg danger- 
ous Lunatics to be at large, but also for the excitement 
which they are apt to cause to the Insane themselves. 
Case of Epilep- An Epileptic Lunatic who escaped from Mr. Kent's 
GatesheadVll ^^y'^'^'^' ^t Gateshead Fell, near Newcastle, in Decem- 
ber, 1842, was, at the time of his escape, employed with 
a number of other Patients upon the Proprietor's farm. 
He was immediately pursued, but was not retaken. 
Application was made by the Proprietor to the police, 
but the wife of the Lunatic interceded, and he was not 
sent back to the Asylum. He escaped on the Saturday 
afternoon, and on the Monday night after his escape 
he murdered his wife and daughter, in a violent 
paroxysm of epileptic mania, in a most savage and 
horrid manner. 

This wretched man is nowa furious criminal maniac in 
the Licensed House from which he escaped, although 
he was so far recovered as to be on the point of being 



73 

discharged. When he had escaped, he became so ap« 
prehensive of being retaken, that he did not dare to go 
to his own house, and it was only upon the intercession 
of his wife with the authorities that he was permitted 
to remain at large. 

At a private Asylum at Dunnington, near York, Escapes at 
there were when we visited it three dangerous Patients, ^^g^j, York •* 
one of whom had threatened the life of a brother, 
another the life of his wife, and a third the lives 
of his wife and child. All these three individuals 
had escaped at different times from the Asylum^ 
Another Patient, an old woman, had also escaped and 
had not been since heard of. It was surmised that she 
might have met with some accident. In this Asylum, 
there was only one insufficient yard both for the Males 
and Females, and the House was unfit for the safe cus- 
tody of the Patients without locking them up in their 
day rooms. 

At Sandfield, near Lichfield, a Patient had escaped, at Sandfield 

and at Plympton, a criminal Patient had escaped, for the "^^•' Lichfield, 
•' ^ \ _ -^ and at Plymp- 

third time, and neither of them had since been heard of. ton ; 

At Nunkeeling, in Yorkshire, a most dangerous at Nunkeelings 
Patient had escaped three times. We found him in con- '° Yorkshire. 
finement after his third escape. His legs were confined 
by leg-locks ; one arm was chained to his legs, and 
both his arms were fastened behind him. He had twice 
nearly succeeded in killing his keepers,and once in setting 
fire to the Asylum. Both the restraint employed, and 
the extremely small yard in which this man was confined 
were calculated to injure his health. At a Licensed 
House in Yorkshire, we found two Male Patients confined 
in strait-jackets. We thought the restraint impro- 
per, and after some remonstrance with the keeper, 
they were removed. The restraint used for one of these 
Patients was, it was said, to prevent his escaping. He 
promised us not to attempt to escape for a limited time. 
He kept his word ; but after the lapse of the period which 



74 



Improper re- 
straint. 



Escapes at 
Han well. 



Consequences 
of escapes. 



Visitation of 
Paupers by 
Parish Officers. 



was fixedj lie made his escape. This Patient had an 
attendant entirely for himself. The improper restraint 
which we have met with in the Houses at Lainston, 
Plympton, and elsewhere, has been defended on the 
ground of the apprehension of escape. The use, however, 
of restraint is not a proper remedy against escape, except, 
perhaps, in cases of very violent or dangerous Patients. 
We were informed that the escapes from Hanwell had 
been numerous, and we have since been furnished with 
an account of them. From the years 1831 to 1843, 
both inclusive, it appears that the escapes have been in 
all 245. These do not include those cases in which a 
Patient has been almost immediately retaken by the 
servants of the Asylum. The total cost of retaking these 
persons has been 7 SI. 14s. 9d. The greatest number of 
escapes that took place in any one year from 1831 to 
1837, was seventeen ; and from 1837 to 1843, both 
inclusive, the highest number in any year was thirty- 
eight. We are not aware, however, that any serious 
mischief arose from these escapes. 

The above remarks are not made with the view of 
offering any suggestions, but merely of calling attention 
to the" fact that very calamitous consequences may result 
from escapes, and that therefore it is important to take 
every possible precaution to prevent them ; not by the 
use of restraint, but by vigilance and care. It is desir- 
able, also, to ascertain, before a License is granted to the 
Proprietor of a House, that there are proper means 
to keep the inmates in safe custody, without resorting 
to such improper restraint, and confinement in gloomy 
places, as we found practised at West Auckland, Nun- 
keeling, and elsewhere, and which are calculated to 
destroy the bodily health of the patients. 

In regard to the visits of the officers of parishes and 
unions, to their paupers, vre observe that the Medical 
officer in each case generally visits them regularly, and 
at no very distant intervals ; excepting only when the 



75 

paupers are sent from distant counties, wlien there 

appears, for the most part, neglect in this respect. 

We are of opinion that no pauper should be sent to Paupers should 

any Asylum which is at a great distance from the distant Asy- 

parish or union to which he belongs ; in order that there ^"™®' 

may be no excuse for not "visiting him regularly, and 

no motive (such as the saving of expense) to prevent or 

delay his removal home, when reported convalescent. 

We find, upon inquiry at various provincial Asy- Visits of fiieads 
lums, that the friends of pauper patients are allowed unties, 
to visit them on certain days in the week, or on all 
days of the week, excepting Sundays. It is worth con- 
sideration, whether the Asylums should not be open, 
during certain hours, on Sundays also, to the visits of 
the friends of poor lunatics, whenever they are in such 
a state of health as to render such visits not injurious. 
Those friends, for the most part, belong to the labour- 
ing classes of the community, and if they are to be 
precluded from visiting the patients on the only day on 
which they themselves are unoccupied, the probability 
is that the pauper lunatic, whilst he remains in an 
Asylum, may be altogether denied the comfort of a 
visit from his friends. In all cases where it may be 
advisable to refuse the admission of the friends, the 
reasons for such refusal should be stated in writing by 
the Medical officer. 

In regard to the visits made to private patients, Visits to Private 
these appear, in general, to be made with sufficient 
frequency, so long as any probability of cure exists. 
When the patients become incurable, these visits, in 
many cases, become more rare. 

It is customary, in all respectable Licensed Houses, to 
allow any near relation of the patient to visit him, at 
proper times, unless the state of his health should render 
such visits unadvisable. There are, however, occasions 
when the proprietor of the Asylum considers himself 
bound to submit, in this respect, to the directions of the 



76 



person under whose authority the patient is first con- 
fined. In one instance, the trustee of an insane lady, 
confined in the Asylum at Laverstock near Salisbury, 
was for a long time refused admittance to the patient, 
by the directions of the person who had authorised her 
confinement ; and the Proprietor of the Asylum, in 
answer to our question on that head, said that he con- 
sidered himself bound to obey those directions, whether 
the visit of the Trustee to his Patient would be likely to 
benefit her health or not. In another case, where a 
male patient was confined at the Asylum at Southall, 
in Middlesex, on the authority of his son, his daughter 
was, by the son's order, arbitrarily prevented from visit- 
ing him. There did not appear to be any reason for 
the exclusion. The power thus vested in any person to 
prevent the access of a child, or near relation, is obvi- 
ously liable to great abuse. 

Our attention has been drawn to the position in 
which Lunatics, who have not been the subjects of Com- 
mission, are placed with respect to their property, whilst 
Liberality usual they are confined in Asylums. Many persons are most 
liberal to their unfortunate friends whom it has become 
necessary to put under the restraint of an Asylum, and 
we have seen many instances of great liberality on the 
part of the Proprietors of Licensed Houses, in maintain- 
ing their inmates, for many years, as Private Patients, 
at considerable expense, with little, and in some cases 
no prospect of reimbursement. Some cases, however, 
have been stated to us where the party is believed to 
be entitled to a considerable income, and a small por- 
tion of it only is applied to his maintenance ; others, 
where the whole property has been applied by Trustees, 
or others, to their own purposes, and the Lunatic has 
thus been left entirely destitute. Other cases again 
have occurred, in which the patient has been allowed, 
whilst in the Asylum, or during a temporary visit to his 
friends, to execute instruments materially affecting his 



Position of 
Lunatics with 
respect to their 
property. 



towards Luna^ 
tics. 



Cases of Pecu 
lation. 



77 

property. We have not had the means of testing the 
accuracy of these statements. 

Our attention has been called, in the course of our 
visitations, to the following, among other cases, upon 
the correctness of which we have every reason to rely. 

W , an Imbecile, was for many years confined at Case in Dr. 

Dr. Warburton s House, at Bethnal Green. Upon his Ho^'g^^"''"'''' 

father's death, he was allowed to go out of the Asylum 

for some hours : he went to his sister's house, and, 

whilst there, signed some deeds, the nature of which he 

did not understand, but was told that he was to share in 

his father's property, whose heir he was. He is now a 

Pauper, in the Asylum for the County of Surrey. 

A Gentleman, now in Dr. Finch's House at Laver- in Dr. Finch's 
stock, had formerly a large property. For many years ""^^ ' 
Dr. Finch has received nothing, and there is a very 
large sum owing to him for his maintenance, and he is 
still furnished gratuitously with the comforts and ac- 
commodations of a private Patient. ' 

Mr. H., an Idiot in Mr. Jackson's House at Turnham in Mr. Jack- 
Green, had £400 a year in the funds, left to him by " ' 
his father. The executors paid the dividend, for some 
years, but ultimately absconded, having misappropriated 
the funds, and the poor Idiot is now destitute. Miss B., 
who was under confinement for several years at Dr. 
Tukes' House, had £2000 left to her by her father. 
The executor employed this sum in his business, and 
the whole was lost. 

There are two brothers. Paupers in Dr. Warburton's in Dr. War- 

TT ^1 1 1 r 1 • r ^ • 1 burton's House: 

Jtlouse, the elder or whom, we are intormed, is supposed 

to have become entitled to property worth £20,000. 

One of them is generally employed as a tailor, but he is 

so lost that he does not know where he comes from, and 

the other brother is in a worse state. 

We would also recall your Lordship's recollection to before the Lord 

a case, which not long since came before your Lordship '-'haiicellor. 

in consequence of a commission of lunacy, namely, that 



78 



Provision for 
protection of 
Lunatics' pro- 
perty wliere no 
Commission 
issued recom- 
mended. 



of R, P. H., who was very properly placed by his bro- 
ther in an Asylum, and which brother immediately 
took possession of all his property, producing an income 
of upwards of 400?. a year, and remained in possession 
of it until his death in 1840, applying only a very 
trifling part of such income to the Lunatic's support 
and then died insolvent.* 

- We beg- to submit for your Lordship's consideration, 
whether some provision might not be made for the 
protection of the property of Lunatics, who shall have 
been in confinement for more than a fixed period, and 
where no Commission has been applied for. It has 
been suggested that where a Lunatic has been confined 
for six or twelve months, a verified statement might be 
required to be made by the persons upon whose order he 
is detained, as to the amount and nature of his property ; 
and some security might be required for its dueadminis-. 
tration, or an ofiicial Trustee be appointed for that 
purpose. 
It has also been suggested, that in cases where the 

* The particulars of this case are as follows : — In July, 1805 
R. P. H. was placed hy his brother in the Asylum of Dr. Burman 
at Henley in Arden. He was at the time entitled to freehold pro- 
perty in Northamptonshire, and Somersetshire, and Gloucestershire, 
now producing an income of more than 460/. a year ; and was also the 
owner of the advowson of a living worth 300/. a year and upwards. 
He also held a commission in the army. The brother sold the com- 
mission, and cut timber, and received the proceeds of each, and the 
rents of the freehold property from 1805 to October, 1840, when he 
died. He was also in 1807, being a clergyman, instituted to the 
living, under a paper to which he procurecf the signature of his brother, 
when in the Asylum. 

The brother died in 1840, perfectly insolvent, and having only 
applied about 120^ a year for the maintenance of the Lunatic, and 
even that sum was often much in arrear, and for some period before his 
death was not paid at all. The brother had also received money in 
respect of a fee-farm rent of the Lunatic, which he professed to sell, 
and also in respect of a further mortgage, which he professed to make 
on the Lunatic's property. On the death of the brother a commission 
was taken out in 1841 by Messrs. Burman, and the jury found R, 
P. H. to have been of unsound mind from the 2nd of July, 1805, and 
the property has since been protected. 



79 

malady is likely to be of short duration, or the property 
of the Patient is small, a competent portion of the 
income might, during a limited period only, be applied 
for his maintenance, under the sanction of one of the 
Commissioners in Lunacy,* acting with the consent of 
the nearest relatives, and of the former having the con- 
trol of the fund : and that the written instructions of 
the Commissioners to that effect, issued under such 
circumstances, should be a sufficient warrant for such 
application. 

We are aware that these are matters of considerable 
delicacy ; and that they do not, at least directly, fall 
within our proper province. At the same time, as they 
have not unfrequently come under our observation in- 
cidentally, and appear in themselves to deserve serious 
consideration, we hope to be excused for having thus 
ventured to call your Lordship's attention to the subject. 



II. 

CONDITION OF PAUPERS ON ADMISSION. 

No subject to which our attention has been given, Evils resulting 

is of deeper interest and importance than the inquiry ^•"^ "^^^^^ ^^ 
^ '■ . sending Pauper 

directed to be made (5 & 6 Yic. c. 87, s. 11) "into Lunatics to 
the condition as well mental as bodily of the pauper ^ ^ 
patients when first received into Asylums, and whether 
this has been such as to prevent or impede the ultimate 
recovery either mental or bodily of such patients." And 
this subject is of the greater moment, inasmuch as 
the evils resulting from the delay in sending pauper 
lunatics to Asylums is, we fear, to some extent, appli- 

* Appointed under ttie 5 and 6 Vict,, c. 84. 



80 



Pi-actice of 
detaining Pau- 
per Lunatics, 
long after the 
attack of 
mental disease 
iu Work- 
houses. &c. 



cable to the cases of private patients, in all classes of 
society. 

Although it appears that pauper lunatics, in some 
few districts of England, are sent to Asylums soon after 
the first attack of mental disease, we have found, that 
the practice of detaining them for long periods subse-- 
quently, (either in Workhouses, or as boarders with 
their friends, or elsewhere,) prevails to a very large extent 
throughout the kingdom. In order to bring this subject 
in a more distinct manner, before your lordship, and to 
show the evils which result from it, we beg to call your 
Appendix (C). lordship's attention to Appendix (C.) at the foot of 
this report. This appendix contains the answers given 
to our inquiries, by the Medical Superintendents and 
Visiting Physicians of the different County Asylums 
and Public Hospitals for lunatics, and by the proprietors 
of a large number of licensed houses into which paupers 
are admitted. 

In the Asylums of Lincoln, Leicester, Nottingham, 
and Northampton, the Superintendents and Visiting 
Physicians of those institutions have expressed their 
unanimous opinion, that pauper lunatics are sent there 
at so late a period of their disease, as to impede or 
prevent their ultimate recovery. Opinions, to nearly the 
same effect, have been given by the medical superintend- 
ents of every County Lunatic Asylum, with the excep- 
tion of those of the Asylums for the counties of Bedford 
and Stafford. It is right to remark that, in some in- 
stances, there has been a reluctance to express any opinion 
as to the bad and hopeless condition in which pauper 
lunatics have been taken to Asylums, from a fear of 
offending either parish officers or other persons. 

At the Retreat, York, at the Asylums of Lincoln and 
Northampton, and at the Asylum for the county of 
Suffolk, tables are published, exhibiting the large pro- 
portion of cures effected in cases where patients are 
admitted within three months of their attacks, the less 



81 

proportion when admitted after three months, and the 
almost hopelessness of cure when personsjare permitted 
to remain in Workhouses or elsewhere, and are not sent 
into proper Asylums until after the lapse of a year from 
the period when they have been first subject to insanity. 
The Asylums for the counties of Lancaster and Middlesex 
and for the West Riding of the county of York have 
published statements to the same effect. In the Dorset 
County Asylum, out of tliirty-seven cases admitted in 
the year 1842, only six were received within three 
months after their first attack. Five of these six re- 
covered, and were discharged within four months from 
the time of their admission, and the sixth, a female, 
aged seventy-five, was improving at the time of our 
visit. 

In the year 1842, the cures in St. Luke's Hospital Average of 
averaged seventy, and in the year 1843, sixty-five, per Luke's. 
cent., a fact which, even taking into account the circum- 
stance of their receiving only recent cases, and such as 
are supposed to be curable, is calculated to remove the 
reluctance commonly felt to send the insane to Asylums, 
and to exhibit the great importance of removing Luna- 
tics as soon as possible after the first appearance of 
disease, to institutions where proper medical treatment 
can be obtained. 

The reasons principally assigned for the insane poor Reasons as- 
being sent so late to Lunatic Asylums, have been the ^'^"^ se°nt^so' 
ignorance of overseers and guardians of the poor as to l^*^- 
the importance of early medical treatment in cases of 
insanity, and their reluctance to send paupers to Lunatic 
Asylums, on account of the great additional expenses 
incurred in those establishments beyond the ordinary 
cost of maintenance in Workhouses or in lodgings. There 
can be no doubt that both these causes have operated to 
a great extent, in improperly detaining paupers from 
Lunatic Asylums. There are, however, other circum- 
stances, which, as we conceive, have still greater influence 

G 



82 



Want of accom 
modation for 
insane poor. 



in causing this serious evil. Even if there did exist en 
the part of guardians and overseers of the poor a full 
knowledge of the importance of early treatment, and the 
most earnest desire to avail themselves of its advantages, 
throughout almost the whole of England, and in the 
whole of Wales, there is so great a want of accommoda- 
tion for the reception of the insane poor, that they could 
not carry their views into effect. 

A mere summary of the total number of insane poor, 
and of the total amount of accommodation provided for 
them in the different public and private Asylums 
throughout the kingdom, would not, by showing the 
general insufficiency of Asylums for their reception, 
expose all the inconveniences and evils which result 
from the present system of managing pauper lunatics. 
We shall submit, however, as accurately as is in our 
power, the details of the numbers of insane poor, and 
the extent of accommodation provided for them in 
different counties ; for the purpose of explaining the 
grounds upon which we have formed our opinion, as to 
the causes which combine, with the reluctance and mis- 
taken economy of parish authorities, to produce this 
serious evil. 
Appendix (D). "We have annexed, in Appendix (D), a detailed account 
of the numbers of pauper lunatics, and of the accom- 
modation for them : — First, in those counties which 
have Lunatic Asylums erected exclusively for paupers, 
and also in those counties which have Lunatic Asy- 
lums for paupers erected in union with subscription 
Asylums; — Secondly, a statement of the numbers of 
pauper lunatics in every county, and the entire accommo- 
dation whether public or private for them ; — And thirdly, 
a list of those counties and districts which have no 
Lunatic Asylums of any description, either public or 
private, and the numbers of pauper lunatics contained 
in them. 

From the statements in Appendix (D), it is apparent, 



83 

first, that in those counties in which Lunatic Asylumshave Difficulty <yf 

. ji'ii • obtaining ad- 

been erected exclusively for paupers, and also m those m n,ission for 

which Lunatic Asylums for paupers have been erected Pauper Luna- 
•' -^ ^ tics in recent 

in union with subscription Asylums, there are large cases. 

numbers of insane poor for whom there is no room, owing 
to nearly all the Asylums being full of patients. Even in 
those counties, therefore, where there are public Asylums, 
there frequently exists difficulty in obtaining admission 
for recent cases. Secondly, it will be seen that in those 
counties where there are public and private, and in some 
instances, only private Asylums receiving paupers, there 
is a striking deficiency of accommodation. Thirdly, it is 
apparent that in eleven counties in England and in all 
the counties in Wales, with two exceptions, there are 
no public or private Asylums of any kind, and conse- 
quently the insane poor must ba sent to distances from 
their own homes, at a greater expense than if there were 
Asylums near at liand. This circumstance is of itself 
calculated to increase the unwillingness of overseers and 
parish officers to send patients, in proper time, to 
these Establishments. 

As regards the state of pauper Lunatics in counties ^'^^^ "^ Pauper 

. Lunatics wliere 

havmg County Asylums, we must remark that the there are Coun- 
Asylums for the counties of Chester, Cornwall, Dorset, ^^ Asylums. 
Lancaster, Middlesex, Stafford, Suffi^lk, and for the 
West Riding of York, have all been reported to our 
board as having been found in a very crowded state. 
In the Workhouse at St. Austle in Cornwall, the Visit- 
ing Commissioners found a woman in a state of raving 
mania. The master of the Workhouse had applied to 
the County Asylum at Bodmin, for the admission of this 
person, but it was so crowded, that her admission had 
been refused, and it was only upon urgent application 
that she was subsequently received. In this County, 
there were 153 lunatics in Workhouses and other places 
out of the County Asylum. At the Asylum, at Forston, 
for the County of Dorset, where the Superintendent has 
G 2 



84' 

for a long time exerted himself to expose and remedy 
the evils resulting from cases being kept back from the 
Asylum, the Visiting Commissioners met with another 
instance during their visit, in which the admission of a 
patient was delayed for want of room. In this County, 
there were 114 pauper lunatics in "Workhouses and 
other places out of the County Asylum. 
Asylums have Jn addition to the above facts, it must be observed, as 

been necessarily . /-< • 

enlarged. a remarkable circumstance, with respect to Counties 

having public pauper Lunatic Asylums, that it has 
been found necessary to enlarge almost every Asylum of 
that sort that has hitherto been erected. The Asylums 
for the counties of Bedford, Cornwall, Gloucester, Kent, 
Lancaster, Leicester, Middlesex and Nottingham, and for 
the West Riding of York, have all been enlarged, and 
some of them several times. The Leicester Asylum was 
opened in 1837, and had additional accommodation made 
for fifty paupers in 1841. The Bedford Asylum has 
been twice enlarged. We were informed that the second 
additions were made with the view of receiving pauper 
lunatics from other counties, and thus diminishing the 
cost of maintaining the pauper lunatics of the county of 
Bedford. This circumstance may, in some degree, ex- 
plain the reason, why in the county of Bedford, paupers 
have been sent in good time to the county Asylum. In 
the Hanwell Asylum, and also in the Surrey Asylum, 
(opened only in 1841,) and in some of the other Asylums, 
the basement stories have, contrary to the original 
intention, been brought into occupation for patients. 

Increasing num- We have mentioned these instances, as we are 

bei- of incura- a,nxious to draw your Lordship's attention to the 
ble cases. •' ^ 

important fact that, however sufficient for the pauper 

lunatics of a county any Lunatic Asylum may have 

! been at the period of its original erection, it has 

subsequently, and in many instances in a very short 

period, become insufficient, and is at the present 

time crowded with a large and increasing number of 



85 

incurable cases. And that we do not assert this on 
slight grounds, the following Table, exhibiting the num- 
ber of inmates in every county Asylum erected exclu- 
sively for paupers, and also in every county Asylvim for 
paupers erected in combination with subscription Asy- 
lums, will make abundantly evident. 



County Asylums. 


County and Subscription Asylums. 


Bedford . . 
Chester . 
Dorset . • 
Kent . . . 
Lancaster . 
Middlesex 
Norfolk . . 
Suffolk . . 
Surrey . . 
YorkVV.R. 


Cura- 
ble. 


Incur - 
able. 


Total. 


Cornwall . 
Glos'ter , 
Leicester . 
Nottingham 
Stafford . . 


Cura- Incur- 
ble. 1 able. 


Total. 


27 
48 
14 
22 
65 
58 
108 
27 
20 
48 


112 
116 
139 
227 
546 
917 
56 
179 
362 
384 


139 
164 
153 
249 
601 
975 
164 
206 
382 
432 


13 
59 
63 
37 

48 


120 

198 

68 

88 

197 


133 
257 
131 
125 
245 



Your Lordship is aware that the Legislature has not 
only given to Justices of the Peace the management of 
County Asylums, but also, (as a necessary adjunct, to 
carry into effect the objects for which they are erected,) 
the disposal of all the Pauper Lunatics in their respective 
counties. By the act of 9 Geo. 4, c. 40, sec. 36, the Jus- 
tices " acting for any county in England " are required to 
issue their warrants to Overseers to return lists of all 
insane persons chargeable to their respective parishes, 
specifying the " name, sex, and age of each insane per- 
son, and whether such insane person be dangerous, or 
otherwise, and for what length of time they have been 
disordered in their senses, and where confined, or how 
otherwise disposed of." These lists are to be verified 
on " oath, with a certificate as to the state and condi- 
tion of every insane person, from a physician, surgeon, 
or apothecary," and are to be transmitted to the Clerk 
of the Peace, to be laid before the Justices at the next 



Disposal of all 
Pauper Luna- 
tics entrusted 
to Justices. 



Return required 
from overseers 
by 9 Geo. IV. 
c. 40, 8. 36. 



86 



K'o system 
adopted by 
County Magis- 
trates for early 
admission of 
Pauper Luna- 
tics into Asy- 
lums. 



Provisions of 
the law have 
not been carried 
into effect. 



Establishment 
and subsequent 
increase of 
Asylum at 
Hauwell. 



General Quarter Sessions. By section 37, any Overseer* 
neglecting to give information of any insane person 
chargeable to his parish, is subjected to a penalty : and 
by section 38, any Justice is empowered to require 
any insane pauper to be brought before tvpo Justices, 
who may cause such pauper to be conveyed to the 
County Asylum, or, if none, to some public Hospital or 
Licensed House. 

The Visiting Justices of County Lunatic Asylums 
have usually taken an interest in the internal manage- 
ment of their Asylums, and have framed rules for their 
government. We have not, however, met with any 
instance in which the County Magistrates have availed 
themselves of the information afforded them by the 
above-mentioned Acts, or have established any system 
for securing the early admission of pauper lunatics into 
the County Asylum. These lunatics are amongst the: 
persons for whose benefit the establishment has been 
erected at a great expense to the county. 

Whether County Magistrates have not been aware of 
the serious evil that was rapidly growing up throughout 
the kingdom, or have been reluctant to rely upon their 
own judgment, or unable to obtain satisfactory medical 
advice for their guidance, it is manifest that the pro- 
visions of the law have not been carried into effect, 
and that the public and the poor have been equally 
deprived of the benefits of these salutary enactments. 
The management of the pauper Lunatics of the county 
of Middlesex, and their present condition, will illustrate 
our remarks. 

The County Asylum at Hanwell was originally erected 
for 300 patients, and was opened in the year 1831. In 
1837 additional wings were built for a further number 
of 360. In 1832, the building, which had been erected 

* The duties imposed by this Act on Overseers, ai-c now transferred 
to the Guardians, as to Parishes which are in Unions. 



87 

for 300, was made to accommodate 500 patients, and 
the Asylum, enlarged so as to contain 650 patients, lias 
been made to hold 1000 beds. This has been effected 
by appropriating to the use of the patients, rooms 
intended for a kitchen, and also offices and places on 
the basement floor, under the level of the adjoining 
ground, not intended to be inhabited. Thus there has 
been introduced a number greater by 350 than the 
Asylum was constructed to hold ; and at the time of 
our visit, in 1844, there were 984 patients in the house. 
There were also in the county of Middlesex, as 
appears by the return made to the Quarter Sessions in Number of 

Paupers for 

1 843, 429 pauper Lunatics for whom there was no whom there 
room in the County Asylum. In the Lunatic wards of j^^CouDt*° A 
the Marylebone Workhouse there were admitted in the ^u™ in 1843. 
years 1842 and 1843, 190 paupers considered as insane. 
Some few of these, however, were stated to be only 
under temporary excitement. The overseers of this 
parish could obtain admission into the Hanwell Asylum 
for only twenty-seven of these 190 cases, and they 
therefore ceased to apply for admissions, and left a 
notice at the Asylum, requesting to be informed when 
any vacancy might occur. They also requested the Refusal of Jus- 
Committee of Visiting Justices to permit them to incurable Pa- 
exchange some of their old incurable patients at the ^^^^^^ ^° ^^ 

° exchanged for 

Asylum for recent curable cases from the "VYorkhouse. curable ones. 

This the Justices refused to do, on the ground that 

the diet was better at Hanwell than at the "Workhouse, 

and that the patients enjoyed more comfort at the 

County Asylum. 

The Rule for the admission of patients in Han- Rule for ad- 
. . 1 1 J J.' i niission of 

well IS, that every parish is entitled to send one patient Patients at 

for every 7000Z. of its rated rental, and every parish not Hanwell. 
rated so high is entitled to send one patient. The 
Magistrates take no steps to ascertain the nature of the 
cases previously to admission, with a view to the pre- 
ference of recent cases. The Parish Officers frequently 



Attempts of 
Justices to com- 
pel overseers 
to send recent 
cases. 



The House 
filled with old 
and incurable 
cases. 



Visiting Magis- 
trates have not 
taken steps to 
secuie admis- 
sion of recent 
cases. 



The cure of 
insanity the 
main object of a 
County Asy- 
lum. 



merely mention the number, •without even the names^ 
of the patients requiring admission. This was the 
information given to us at the Asylum. 

The first Committee of Visiting Justices gave notice, 
in 1831, that they intended to take measures for com- 
pelling the overseers to send to the County Asylum 
" those of their patients whose cases admitted there 
" should be the greatest probability of curing." In 1832, 
they called the attention of the County Magistrates to the 
fact of recent cases not having been sent to the Asylum, 
and they declared the delay to be illegal; and they 
have since repeatedly published Tables and Reports, 
showing the great advantages to be derived from 
cases of insanity being received at the Asylum in the 
earliest stages of the complaint, and the great evils 
resulting from an opposite course. The resident Phy- 
sician called the notice of the Magistrates, in 1834, to 
the " melancholy fact of the house being filled by old 
and incurable cases," which he attributed "almost 
entirely to the neglect of proper remedies in the early 
stages of the disease;" and in 1836 he also stated 
" that the additional room made for the patients 
" during the year had been almost entirely filled up by 
" old and incurable cases, only ten, said to be of recent 
" date, having been admitted." The resident Physician 
has, from time to time, called attention in his Reports 
to the incurable state in which paupers have been 
brought to the Asylum. 

From the foregoing statement it will appear that 
no steps have been taken by the Visiting Magistrates 
of Middlesex, pursuant to their notice in 1831, to secure 
the admission of recent cases, and that, in reference to 
the populous parish of Marylebone, they refused to 
exchange old incurable for recent and curable cases. 
But the professed and indeed the main object of a 
county Asylum is, or ought to be, the cure of insanity. 
The patient who has had the benefit of a trial in the 



89 

Asylum where he has become incurable, should, we 

submit, give way to the afflicted pauper who is in the 

Workhouse or at home, and is probably curable, and 

equally entitled to be received at the Asylum, where, by 

prompt and proper treatment, he may be restored to 

health and to his family, instead of being permitted to 

become an incurable lunatic, a source of expense to 

others, and of suffering to himself. A County Asylum 

is erected for the benefit of the whole county, and is to 

be considered not merely as a place of seclusion or safe 

custody, but as a public Hospital for cure. A large 

number of the patients now in Hanwell derive no Many patients 

substantial advantage from the means of exercise and ^"J^^ uo bene= 

° _ fit from the 

employment furnished in that Asylum, and might be Asylum. 
provided for in a separate Establishment ; thus making 
room for patients who are susceptible of cure. 

The result of the system, adopted by the Justices in Kesult of the 
Middlesex, is, that the County Asylum is nearly filled 'y''^™' 
with incurable Lunatics, and almost all the recent cases 
are, practically, excluded from it. When we visited it 
in March last, there were 984 patients, of whom only 
30 were reported curable ; and there were 429 patients 
belonging to the County out of the Asylum, and 40 
applications for admission had been refused within less 
than three months from the commencement of the 
present year. 

In 1831, there were 300 patients, for whom there was 
no County Asylum whatever ; and in 1844, although 
there is an Asylum holding 984 patients, there are 429 
pauper Lunatics unprovided for, and who, if they wait 
for the rota before they are admitted, will probably 
have become incurable, and will be lunatic annuitants 
upon the county or their parishes. 

There is some difficulty in ascertaining the exact cost Cost of Esta- 
of the Asylum at Hanwell • but we believe that at least ^'^^""^f* ^* 

•' Hanwell. 

160,000/. has been expended upon the land and buildings. 
The maintenance of paupers in this Asylum in the year 



90 



An extension 
of the establish- 
meat likely to 
increase the ac 
cumulation of 
incurable cases, 
■without extend- 
ing the re- 
sources of cure. 



Serious atten* 
tion of the 
Legislature 
called to the 
state of Middle- 
sex with respect 
to Pauper 
Lunatics. 



Condition of 
County of Lan- 
caster. 



1843, cost their parishes 24,049/. l'2s. 6c/., which does not 
include a sum of about 4000/. a year paid by the 
county for the yearly cost of furniture, and the wages 
of mechanics and labourers employed about the ordi- 
nary repairs and work of the establishment. Not- 
withstanding this annual expenditure of 28,000/., and 
an outlay of 160,000/., there are stiU 429 Lunatics 
unprovided for, to be maintained by their parishes. 
We have stated ovir reasons for thinking that the 
Hanwell Asylum ought not to be enlarged. The origi- 
nal cost of Hanwell for 300 patients was 124,000/, 
Supposing a similar outlay for the 429 patients, and the 
cost of maintaining each of these persons to be the 
same as that of a Lunatic in the present Asylum, the 
annual charge on the parishes and county, for tlie Pauper 
Lunatics (besides an additional outlay of 124,000/., 
making altogether 284,000/.) will be 36,000/. And, 
should the magistrates enlarge their accommodations 
and continue their present system of admission, they 
will, apparently, but increase the accumulation of in- 
curable cases, without extending the resources of cure. 

We have called attention to the state of the County 
of Middlesex, with respect to its Pauper Lunatics, 
because, although the evils which exist there, prevail 
to a very great extent in other counties, they have risen 
up in the county of Middlesex with a rapidity which has 
not been equalled elsewhere, and to a magnitude which 
appears to us to require the serious attention of the 
liCgislature. 

The condition of the county of Lancaster shows that 
the evils, which we have pointed out as existing in 
Middlesex, are not confined to the last-mentioned county. 
In 1816, the Lancaster Asylum was opened for 160 
patients. It now contains 600 patients, and there are 
more than 500 Pauper Lunatics in the county, for 
whom it has no accommodation ; and the information 
obtained at this Asylum isj that nearly all of them 



91 

have been brought from "Workhouses, where they have 
been detained so long as to diminish the probability of 
their recovery. The counties of Middlesex and Lan- Peculiar con- 

0.1 1 1 rjL*i.i-'i_ J.X dition of Coun" 

caster have a large class oi patients, which are not met ^jg^ ^f Middle- 
with, in the same numbers, in other counties. The ^'^^ ^^"^ ^^^' 

caster as re- 

county of Middlesex had, in 1841, 108, in 1842, 116, gards Pauper 
and 1843, 126, county Pauper Lunatics, or Lunatics "°^'''=*- 
whose settlement had not been ascertained. The county 
of Lancaster had, in 1842, 118 county Pauper 
Lunatics. 

The Asylum for the county of Surrey was opened in Establishment 
June 1841, and the Visiting Physician went round to «f Asylum for 

' a ./ county or our- 

the different licensed Asylums in which the pauper rey. 
Lunatics were distributed, and selected from them 
299 cases, which were thereupon removed to the county 
Asylum. At the period of our visit in 1843, there 
were 385 cases, including those which had been removed 
from Licensed Houses. All these 385 persons, with 
the exception of only thirty-seven cases, had been 
insane more than twelve months. There were 
(according to the Poor Law returns for 1843,) 591 
pauper Lunatics belonging to the county of Surrey ; and 
the number in the Asylum, on the 1st January, 1844, 
was 382, of whom 362 were reported incurable. We 
inquired at this Asylum if any steps had been taken 
by the Visiting Magistrates to secure recent cases being 
sent there, but we were informed that no measures had 
been adopted for that purpose, and we fear that the condi- 
tion of the county of Surrey, with an excellent Asylum, 
will soon, as regards the cure of its insane poor, be similar 
to that of the county of Middlesex, unless patients be 
sent to the Asylum in an earlier period of their disorder, 
and some plan be devised for disposing of such of the 
incurable cases as it may be necessary, in that event, 
to remove. 

These remarks lead us to another and most important 
cause, which operates to fill Lunatic Asylums with incu- 



92 



Lunacy essen- 
tially different 
from other 
maladies. 



Patients beyond 
reach of medical 
skill should be 
removed from 
Asylums, insti- 
tuted for cures. 



Places of Re- 
fuge should be 
provided for 
Incurable Luna- 
tics. 



Table patients, and to prevent the public from deriving any 
considerable benefit from them as Hospitals for the cure 
of Lunacy ; and this must continue to operate and neu* 
tralise all other efforts for the benefit of the insane, 
unless means are adopted to relieve the Asylums, from 
time to time, from the pressure of incurable patients, 
and to provide for such patients in some other Establish- 
ment. 

The disease of Lunacy, it should be observed, is 
essentially different in its character from other mala- 
dies. In a certain proportion of cases, the Patient 
neither recovers nor dies, but remains an incurable 
lunatic, requiring little medical skill in respect to 
his mental disease, and frequently living many years. 
A Patient in this state requires a place of refuge ; but 
his disease being beyond the reach of medical skill, it 
is quite evident that he should be removed from Asy- 
lums instituted for the cure of insanity, in order to make 
room for others whose cases have not yet become 
hopeless. If some plan of this sort be not adopted, the 
Asylums admitting Paupers will necessarily continue 
full of Incurable Patients ; and those whose cases still 
admit of cure, will be unable to obtain admission, until 
they themselves become incurable ; and the skill and 
labour of the physician will thus be wasted upon 
improper objects. 

Under all these circumstances, it seems absolutely 
necessary that distinct places of refuge should be pro- 
vided for Lunatic Patients who have become incurable. 
The great expenses of a Lunatic Hospital are unneces- 
sary for Incurable Patients : the medical staff, the num- 
ber of attendants, the minute classification, and ^the 
other requisites of a Hospital for the cure of disease, 
are not required to the same extent. An establishment, 
therefore, upon a much less expensive scale would be 
sufficient. 

In illustration of these remarks we call to your 



93 

Lordship's notice the rapidity with which the accu- Rapid accumu- 
mulation of patients has taken place at the Asylum p'l"'^ '* • 
for the County of Lancaster: — From the 25th June, Lancaster Asf- 
1842, to the 24th June, 1843, 267 patients were ad- 
mitted into this Asylum. The discharges during the 
same period amounted to 103, and the deaths to 71, 
and thus were added, in that year, 93 persons, whose 
chance of recovery was diminished by the circumstance 
of it not having been eflfected within the first twelve 
months. A similar accumulation is taking place, Similar accu- 

althouoh not to the same extent, in nearly all the ^"^at'o^iu 

® •' other Asjlums. 

county Asylums; so that a certain and progressive 

increase of chronic or incurable cases is produced, in all 

houses which have no outlet for them, a circumstance 

which seems never to have been contemplated by those 

who have the management of these large public Asylums, 

and for which no relief or remedy has hitherto been 

provided. 

We are glad to remark that the Visiting Justices of Substitution of 

the Asylums for the West Riding of the county of York, "'^"'"^^ ^°^ °^^ , 

•' _ ° J ^ cases permitted 

and for the counties of Nottingham and Stafford, permit in certain 
the substitution of recent for old cases. 

The disposal of incurable patients, however, although Disposal of In- 
a very serious and difficult question, is certainly of less ^^^^g ^ 
moment than the exclusion of curable cases from Lunatic 
Hospitals, which have been erected at great public cost, 
and are fitted up with every convenience for the pur- 
pose of cure. 

As far as we can learn, the admission of patients Admission of 
appears, for the most part, to be either indiscriminate or ^'^^i*^°'^ "^"'^" 

irsT' r •> cnmate or 

matter of accidental arrangement, and has no reference accidental. 
to the urgency of each case. In reference to the length 
of time during which incurable Patients remain in 
Asylums, and the great importance therefore of early 
admissions, with the view of diminishing their numbers, 
it may be observed, that those who recover generally 
do so within the first year after their attack, and 



at Hanwell. 



94 

that those who do not recover within the first two 
years after tlieir attack, seldom regain the use of their 
Table published reason. In reference to this subject, we may state that 
ing Physician" *^^ Superintending Physician of the Hanwell Asylum 
has published a Table, showing the length of time 
during which each patient who was in that Asylum 
in the year 1842 had been confined there. The dura- 
tion of the confinement of the patients in Hanwell, 
however, varies at different times, and may also 
differ from that in other similar establishments. It 
will be seen, by reference to the Table,* that there 
were, in 1842, 936 patients in the Hanwell Asylum, 
of whom 696 had been there more than two years, 
and were reported incurable. The average duration 
of the confinement of these 696 patients had been 
upwards of six years and nine months. The yearly cost 
of each patient at Hanwell, at the rate of 7*. a week, 
and adding 41. per annum, paid by the county for repairs 
and furniture, is 22^. 4*. : Each patient, therefore, who 
has been confined during that period, will have cost his 

* Table showing the length of time during which 936 Patients, 
remaining on September 30th, 1842, had been in Hanwell Asylum. 





1841. 


1842. 


Time. 


M. 


F. 


T. 


M. 


F. 


T. 


Not exceeding 1 Month . 


9 


6 


15 








>J 3 5, . 


14 


17 


31 


7 


7 


14 


)} 6 „ . 


14 


34 


41 


15 


15 


33 


jj 9 jj • 


21 


31 


52 


34 


34 


53 


„ 1 Year . 


8 


7 


15 


13 


13 


26 


55 '^ 5J • 


61 


57 


118 


72 


72 


114 


5) 3 „ . 


34 


43 


77 


49 


49 


97 


4 „ . 


53 


99 


152 


39 


39 


71 


55 ^ 55 • 


12 


15 


27 


95 


95 


143 


55 6 „ . 


30 


18 


48 


14 


14 


26 


55 7 55 • 


15 


24 


39 


18 


18 


47 


)> ° 55 • 


13 


16 


29 


24 


24 


39 


>I 9 55 • 


26 


42 


68 


14 


14 


25 


10 „ 


47 


70 


117 


37 


37 


62 


11 „ ■ 


30 


52 


82 


65 


65 


107 


14 55 ■ 

Total .... 








50 


50 


79 


387 


531 


918 


390 


546 


936 



95 

parish 1401. In reference to this calculation, it 
should not be forgotten, that many pauper lunatics 
have families, who, would no longer be thrown on 
parishes for support, if their mental maladies could be 
removed^ or even materially ameliorated. 

Another fact connected with the condition in which 
the insane poor are sent to Asylums is, we think, cal- 
culated to have a very prejudicial effect. The Poor Extracts from 

-r y-i • • -ii" -ijj J printed orders 

Law Commissioners, in their printed orders and regu- ^^ -p^^^ l^^^ 
lations, have adverted to the 43tli section of the Commissioners. 
Poor Law Amendment Act, which enacts that " no- 
" thing in this Act contained shall authorise the deten- 
*' tion in any "Workhouse of any dangerous Lunatic, 
" insane person, or idiot, for any longer period than 
" fourteen days ; and every person wilfully detaining in 
" any "Workhouse any such lunatic, insane person, or 
" idiot, for more than fourteen days, shall be deemed 
" guilty of a misdemeanour." They remark upon this 
clause, " The words dangerous lunatic, insane person, or 
" idiot, in this clause, are to be read dangerous lunatic, 
" dangerous insane person, or dangerous idiot, according 
" to the opinion of the Law Officers of the Crown, given 
" to the Poor Lai^ Commissioners." The following ex- 
tract is taken from the printed directions of the Poor 
Law Commissioners, as to the detention of lunatics in 
Workhouses, dated the 5th of February, 1842. " From 
" the express prohibition of the detention of dangerous 
" persons of unsound mind in a Workhouse, contained 
" in the clause just cited, coupled with the prevalent 
" practice of keeping insane persons in the Work- 
" houses before the passing of the Poor Law Amend- 
" ment Act, it may be inferred that persons of un- 
" sound mind, not being dangerous, may be legally 
" kept in a Workhouse. It must, however, be remem- 
" bered that with lunatics, the first object ought to be 
" their cure, by means of proper medical treatment. 
'* This can only be obtained in a well-regulated Asy- 



9G 

" lum ; and tlierefore the detention of any curable 
" lunatic in a Workhouse is highly objectionable, on the 
" score both of humanity and economy. The Commis- 
" sioners, indeed, believe that most of the persons of 
" unsound mind detained in Workhouses, are incurable 
" harmless idiots. But, although the detention of per- 
" sons of this description in a Workhouse does not 
*' appear to be liable to objection on the ground of 
" illegality^ or of defective medical treatment, they 
" nevertheless think that the practice is often attended 
" with serious inconveniences, and they are desirous of 
" impressing upon the guardians the necessity of the 
" utmost caution and vigilance in the management of 
" any persons of this class who may be in the Work- 
" house." 
Opinion of Poor "W'e entirely concur in the opinion expressed by the 

Law Commis- -n -r r^ • • mi i i • <» 

sioners as to Poor Law Commissioners, " That the detention of any 

Lunatics m « curable lunatic in a workhouse is highly obiectionable, 

VVorknouses. o j j ' 

" on the score both of humanity and economy." We 
think, however, that they must be under some miscon- 
ception as to the condition of lunatics in Workhouses, 
when they represent them as being in general incurable 
harmless idiots, and their detention not objectionable 
on the ground of defective medical treatment. 

The Poor Law Commissioners have, in their return of 

Pauper Lunatics in England and Wales for the year 

1842, returned the numbers of Lunatics belonging to 

Parishes formed into Unions, at that time, at 6451, 

Use of the term and of Idiots 6261. In these Returns, the word 

Law Commis- " I^^iot," is used in a more extensive sense than that 

sioners' returns Jn which it is usually employed by medical men, and 

of Lunatics in i • i i 

Unions. we think that the term ought to be confined to cases 

of congenital idiocy. This will account for the very 
large numbers which have been returned under this 
description, and which, in point of fact, includes a 
large number of lunatics of every class. The return 
would represent that the lunatics of all descriptions 



97 

belonging to Parishes in Unions, throughout England 
and Wales, exceeds that of the idiots only by 190. 

In the year 1843, there were in the Chester Asylum 
167 patients, of whom 39 (an unusually large propor- 
tion) were idiots ; in the Bedford County Asylum 
there were 140 patients, of whom 15 were idiots ; in 
the Cornwall County Asylum there were 147 patients, 
of whom 7 were idiots ; in the Dorsetshire County 
Asylum there were 105 patients, including 2 idiots; in 
the Kent County Asylum there were 253 patients, of 
whom 4 were considered idiots. The above instances are 
given by way of example, and there will be found to be 
a very small proportion of idiots compared with other 
lunatics in the other public Asylums in England. 

As idiots are considered less dangerous than other Idiots often 
lunatics, and may be regarded as being beyond the '^"S^''°"^- 
means of cure, there is, perhaps, a larger proportion of 
them in Workhouses and elsewhere, than is usiially met 
with in County Asylums. Idiots, however, are by no 
means to be considered as persons always harmless. 
Two male idiots of the age of 18 were lately found in 
an Union workhouse committing an unnatural o£fence. 
They were taken before a magistrate, and were by him 
sent back to the Workhouse as irresponsible persons. 
Such individuals should be deemed dangerous, not only 
in the ordinary but in a moral acceptation of the term, 
and ought not, we think, to have been sent back to the 
Workhouse. In the Leicester Workhouse, we found 
(in Oct. 1843) a dangerous female idiot who had 
knocked out the teeth of a child. There are constantly 
instances of idiots exhibiting the most depraved as well 
as the most dangerous propensities. 

The Metropolitan Commissioners are directed by the Workhouses 

act of the 5th & 6th Vic. c. 87, to visit houses visited by Com- 

missioners. 
licensed by Justices of the Peace for the reception of 

insane persons, and also County Lunatic Asylums. The 

H 



98 



gives Reports 
concerning 
Idiots and Lu- 
natics in Work 
houses. 



Particular 
instances speci' 



act does not direct any visits to Workhouses. In the 
year 1 842, however, we availed ourselves of all oppor- 
tunities to visit such Union and other "Workhouses as 
lay in our road. We obtained also your Lordship's 
authority to visit, in the course of the last year, the 
Union Workhouse at Bath, the Infirmary Bethel at 
Norwich, and the Workhouses at Birmingham, Man- 
chester, SheflS.eld, and at Portsea; and in consequence 
of special information which we received, we were 
induced to visit the several Union Workhouses subse- 
quently noticed. 
Appendix (C.) The reports given in the Appendix (C.) of the Work- 
houses which have been visited by us, will show that 
some of them contain not only incurable harmless idiots, 
but numerous maniacal and dangerous lunatics of every 
class. 

In the Union Workhouse at Redruth, in Cornwall, 
there were forty-one insane paupers, of whom six were 
idiots. Several of them were violent, and at times re- 
quired restraint. In the Union Workhouse at Bath, there 
were twenty-one insane persons, of whom one female 
was constantly under restraint; another was under 
excitement, and secluded in a cell ; and one man had 
been in the house four months without any medicine, 
although his case appeared susceptible of benefit from 
medical treatment. In the Leicester Union Workhouse, 
there were thirty insane persons, of whom three males, 
and nine females, were dangerous lunatics, in the strict 
sense of the word, and most unfit inmates of the place 
in which they were confined, and where, as we were 
informed, they had been long detained, in spite of the 
remonstrances of the visiting Surgeon, and some of the 
Magistrates. In the parish Workhouse at Birmingham, 
there were seventy-one insane persons, sul)ject to insa- 
nity in various forms ; several of them being epileptics, 
liable, after their paroxysms of epilepsy, to fits of 



fied 



99 

raring madness, during which they were usually exces- 
sively violent, and some of them occasionally under great 
excitement, and furiously maniacal. 

Whilst we feel it our duty to state to your Lordship 
the condition in which we have found numerous 
lunatics in the "Workhouses which we have visited, we 
thoroughly appreciate the great difficulties which those 
who administer the Poor Law have to encounter in the 
disposal of pauper lunatics, by reason of the insufficient 
provision made for their reception in proper Asylums. 
We think, however, that the detention in Workhouses, 
not only of dangerous lunatics, but of all lunatics 
and idiots whatsoever, is highly objectionable. 

The clause which is supposed to sanction the confine- Confinement in 
ment in Workhouses of lunatics, without adverting to Lunatics^^ob-** 
the probability of their being curable or not, provided jeetionable. 
they be not dangerous, is, in our opinion, impolitic, 
and open to serious objection. Although a patient may 
not be violent or raving, he may require medical treat- 
ment, and it is at the beginning of attacks of insanity, 
when the causes of the disease are in most powerful 
operation, and the symptoms are developing themselves, 
that the skill of a medical officer experienced in this 
disease is most required. Our objection to the clause 
of the Act to which we have referred is, that it has a 
tendency to impress upon those who have the care of 
the poor, the belief that there is no harm in keeping 
lunatics away from Asylums so long as they are not 
dangerous, and thus to combine with the other causes 
which we have pointed out in producing that incurable 
condition in which pauper lunatics are so often sent 
to Asylums. The clause seems, moreover open to this 
observation, — if it really sanctions the detention of 
harmless lunatics, — namely, that the Parish Authorities 
may take advantage of it to deprive persons of their 
liberty, although they would do no harm if at large. 
, If, notwithstanding these objections, a necessity 
H 2 



100 



Exercise and 
occupiation 
should be pro- 
cured for harm- 
less Idiots. 



Formidable 
increase of 
Incurable 
Patieiits. 



exists for detaining any of the insane poor in Work- 
houses, care should be taken to secure for them proper 
treatment, by persons experienced in the diseases of the 
insane. The law has provided that all houses licensed 
for the reception of lunatics, shall be regularly visited 
by a medical man, and that such medical man shall 
make and sign a statement of the health of all the 
patients once in every week. The ordinary medical 
attendants, however, of Union and other Workhouses, 
are not always persons conversant with the treatment 
of insanity. Even for harmless incurable lunatics, 
proper means of exercise and occupation ought to be 
provided, and experienced attendants ought to be em- 
ployed. Yet, at the Bath Union Workhouse there 
were nine Insane females under the care of an aged and 
' feeble woman, who was stated to be upwards of ninety 
years old. One woman under her charge was always 
confined in a strait waistcoat, and another was in a state 
of great excitement, and secluded in a solitary cell. 
When this feeble woman was unable to manage the 
female patients, her practice had been to call in the aid 
of an old man who had the charge of the male lunatics. 
In the Leicester Workhouse, there were nineteen female 
lunatics, some of whom were extremely dangerous. 
Some of these persons were found shut up in a small 
refractory ward, without any attendant. We were told 
that it was the duty of a female servant to look in upon 
them once an hour, but that she feared to remain with 
them. 

It will be seen from the foregoing statements, to what 
a formidable extent the number of incurable patients 
have increased in many of the public Asylums. And 
this seems to have arisen principally from two causes, 
viz. : — 1st. The detention of patients in Workhouses or 
elsewhere, until they were past the chance of recovery ; 
and 2ndly. The want of any separate Establishment 
to which patients could be sent when they became 
incurable. 



101 

It is manifest, indeed, either that County Asylums Increase to be 
must, in their original construction, have been made gonjg measure 
inadequate for their purpose ; or that, from some cause, *", system of 

T- ^ ^ admission m 

insanity has since increased. And there can be no large Asylums. 
doubt, we apprehend, but that there has been a great 
increase in the numbers of lunatics, and that this is to 
be ascribed, in some measure, to the system of admis- 
sions and general arrangement which prevails in the 
large Asylums, and which has prevented the poor and 
the public from obtaining the full benefit intended to 
be afforded by those Institutions. Should the system of 
detaining curable patients from Asylums until they are 
beyond cure, and sending thither those only who are 
incurable, still continue, it is difficult to foresee the 
extent to which the numbers of incurable Lunatics may 
increase, especially in some of the populous Counties. 

If incurable Lunatics should be allowed to reside in 
Unions or Workhouses, it is indispensable that they 
should have separate Wards and Airing-grounds, to- 
gether with proper Diet and superintendence, and that 
these Wards should be visited regularly, like other 
Lunatic Asylums. We think, however, that it would 
be far better that they should be provided for at a 
distance from the ordinary Poor, to whom they might 
be a subject of annoyance, and who might themselves 
become a source of irritation to the Lunatics. And 
there can be no doubt, we apprehend, but that the 
comfort and proper treatment of Lunatic Patients 
would be secured much more effectually in a distinct 
Establishment. Whether the existing Asylums, which Question 
contain a very large number of Patients, can be rendered ^^Jj^^^,i^^l ' 

efficient Hospitals for the treatment of curable Patients can be reudered 

. efBcient Hospi- 

only ; or whether they may not be exclusively appro- tals for curable 

priated advantageously to the use of incurable Lunatics, 

is a question that may deserve future consideration. 

When we call your Lordship's attention to the 

fact that the number of Pauper Lunatics in England 



Patients. 



102 

and Wales appears to be about 17,000, and that there 
is accommodation in county Asylums for not more than 
4500, we do not recommend the providing public 
Asylums for such a number of persons upon the expen- 
sive scale on which county Asylums have hitherto been 
Suitable places erected. We submit, however, that it is the duty as 

for reception of . 

recent cases Well as the interest of the public to provide suitable 
*d d th^'^r places, in every county or within certain districts, where 
delay. recent cases may be received without delay. 



III. 

FORMS OF DISEASE, MEDICAL TREATMENT, DIET, 
AND CLASSIFICATION. 



Principal forms ^^ ^^"^® thought it expedient in this place to dis- 
of Insanity dis- tinguish the principal forms of Insanity which are 

tinguished. * . . , . 

usually met with in Lunatic Asylums, in order to 
render more clear and intelligible the statements which 
we are about to make respecting the classification and 
treatment of their inmates. They may also be useful 
in illustrating the Statistical Tables which wiU be 
found in the Appendix. 

The principal forms are comprehended, in the Tables 
which accompany this report, under the following 
heads : — 

I. Mania, which is thus divided : I 

1. Acute Mania, or Raving Madness. 

2. Ordinary Mania, or Chronic Madness of 

a less acute form. 

3. Periodical, or Remittent Mania, with 

comparatively lucid intervals. 
II. Dementia, or decay and obliteration of the intel- 
lectual faculties 



103 

III. Melancholia. 

IV. Monomania. 
V. Moral Insanity. 

The three last mentioned forms are sometimes com- 
prehended under the term Partial Insanity. 

VI. Congenital Idiocy. 
VII. Congenital Imbecility. 
VIII. General Paralysis of the Insane. 
IX. Epilepsy. 

To these heads may perhaps be added "Delirium 
Tremens," since it is mentioned, as a form of Insanity, 
in the Reports of some Lunatic Asylums. 

A few brief descriptions of the disorders to which 
these terms are appropriated, may be deemed requisite 
by way of explanation. 

I. Mania. — This term is used to designate a par- (N^jjejal defini- 
ticular kind of madness, as affecting all the opera- tion of Mania, 
tions of the mind. Hence the term Total or General 
Insanity is used as synonymous with Mania. Maniacs 
are incapable of carrying on, in a calm and collected 
manner, any process of thought; their disorder for 
the most part betraying itself whenever they attempt 
to enter into conversation. It likewise affects their 
conduct, gesture, and behaviour, which are absurd and 
irrational ; their actions being characterized by great 
restlessness, appearing to be the result of momentary 
impulses and without obvious motives. Mania is also 
accompanied by hurry and confusion of ideas, and by 
more or less excitement and vehemence of feeling and 
expression. When these last symptoms exist in an 
excessive degree, the disorder is termed Acute Mania or 
Raving Madness. 

1. Acute Mania or Raving Madness is the first stage Acute Mania. 
of the disease, which often becomes gradually milder in 
its character, and is then termed Chronic Mania or 



104 



simply Mania. In other cases, the disposition to high 
excitement or raving continues through the whole 
course of the disease, which sometimes becomes fatal 
through the exhaustion occasioned by perpetual agita- 
tion and want of rest. It is also generally attended 
with considerable disturbance of the vital functions. 
Chronic Mania. 2. The Chronic Form of Madness is attended with less 
excitement of the' passions, less rapidity of utterance, 
and less violence of action. In this stage, the disorder of 
the mind is not always immediately perceptible ; but it 
soon becomes apparent that the patient is incapable of 
continued rational conversation or self-control, and that 
his acts are the results of momentary caprice, and not 
governed by rational motives. A great proportion of 
Maniacs labour under Illusions and Hallucinations^ or 
false impressions as to matters of fact, but in these 
illusive notions there is no consistency or permanence. 
Patients labouring under this chronic form of Mania 
are often tolerably tranquil and harmless. Many of 
them are capable of being employed in agricultural and 
other active pursuits, and of amusing themselves by 
reading, music, and various entertaining games. A 
great proportion of the inmates of Lunatic Asylums 
belong to this class. However quiet and manageable 
they may appear to be under the authority and super- 
vision to which they are subjected in an Asylum, they 
are quite unfit to be at large and to mix with ordinary 
society. 

3. Intermittent Mania or Madness attended with 
lucid intervals is by no means so frequent as might 
be inferred from the writings of authors on medical 
jurisprudence. Some medical writers, of considerable 
note, have denied the existence of lucid intervals alto- 
gether. The fact is, that in all large Asylums, there are 
patients subject to occasional paroxysms of raving mad- 
ness, but who have intervals of comparative tranquillity 
and rest. It generally Iiappens that after the alterna- 



Intermittent 
Mania. 



105 

tions of raving fits and periods of tranquillity have 
continued for some time, the intervals become less 
clearly marked, and the mind is found to be weak- 
ened, the temper more irritable, and both ^the feelings 
and the intellectual faculties more and more disor- 
dered. 

Recurrent Insanity differs from Intermittent Mania, Distinction 
though often confounded with it. ' In Intermittent jgnt Insanity 
Mania paroxysms occur either after regular or irre- ^^^ Intermit- 

^ •' _ ° tent Mama, 

gular periods, and this is the ordinary character of 

the disease. Recurrent Insanity is a name applied to 

any form of mental disorder, when the patient recovers 

perfectly, but suffers from relapses after considerable 

periods of time. 

II. Dementia. — Chronic and protracted mania is fre- Dementia, 
qnently the prelude to a decay and final obliteration of 
the mental faculties, which is termed Dementia. 

Dementia differs from all other forms of insanity. It 
differs from Mania, in which the intellectual powers 
still exist, though they are exercised in a confused and 
disordered manner. It differs from Idiocy, in which 
the powers of the mind have never been developed, 
while in Dementia they have been lost. 

Dementia is, in some instances, the primary form of 
mental derangement, and its phenomena make their 
appearance in the first onset of the disease. Cases of 
this kind are chiefly from causes of a depressing nature, 
such as deep and overwhelming grief, extreme poverty, 
destitution, and old age. In those instances in which 
dementia is the sequel of protracted mania, it is not 
easy to determine the point at which mania ends, and 
dementia begins. It is sometimes, also, the sequel of 
epilepsy, apoplexy, paralysis, and other affections of the 
brain. 

In most large Asylums the prevailing forms of Mania and 
insanity are Mania and Dementia. In the collective I^^™<'°ti* pr«" 

"' vailmg forms of 

numbers of Patients in the Lancaster County Asylum, Insanity in 

large Asylums. 



106 

the Superintendent has furnished the following state- 
ment, viz., Out of 619, reduced to 580 by the omission 
of 39 doubtful caseS; there were labouring under mania 
235j and dementia 183=418, which is about two ■ 
thirds of the whole number of the Patients. 
Melancholia. ; HI, Melancholia. — A considerable proportion of the 
inmates of all extensive Lunatic Asylums, are the 
Melancholies ; among whom there are several degrees 
and varieties. Some patients display merely lowness 
of spirits, with a distaste for the pleasures of life, 
and a total indifference to its concerns. — These have no 
disorder of the understanding, or defect in the intellectual 
powers, and, however closely examined, manifest no delu- 
sion or hallucination. This state often alternates with an 
opposite condition of the mind, namely, one of buoyancy 
of spirits, and morbid activity^ It is thus frequently very 
difl&cult to determine in what degree Melancholy, when 
it exists without delusions, constitutes insanity. A 
great number of persons whose disorder is precisely 
that which is above described, and who betray no 
particular error of judgment or hallucination, are con- 
fined in Lunatic Asylums as a precaution against suicide, 
to which they are prone, in many instances, from a 
disgust of life. 

Another class of Melancholies derive their grief and 
despondency from some unreal misfortune, which they 
imagine to have befallen them. Many are convinced 
that they have committed unpardonable sins, and are 
doomed to eternal perdition. Others believe themselves 
to be accused or suspected of some heinous crime, of 
which they are destined to undergo the punishment ; 
and of this they live in continual dread. Some 
fancy that they have sustained great pecuniary losses, 
and are utterly and irretrievably ruined. A numerous 
class of melancholy patients live under the impression 
that they labour under some terrible bodily disease. 
Many of them have, in reality, some complaint of 



107 

which they magnify the symptoms : they fancy every 
trifling sensation of a painful kind to be certain indica- 
tions of their incurable distemper, which they often 
attribute to some fantastical cause. 

Melancholy patients require particular care and Particular care 
constant inspection, on account of the frequency of melancholy 

suicides among persons of this class. In the Report patients to pre- 

. , . , . ^ vent suicide. 

of the Patients admitted into the Jforthampton Asylum 

from August 1838, to November 1843, out of 118 
cases of Melancholia, a suicidal propensity had been 
discovered in sixty-four.* The suicidal propensity is 
not, however, restricted to this class of patients. In a 
late annual Report of the Lancaster County Asylum, 
there are only forty-five cases of Melancholia men- 
tioned, while it is stated that a suicidal propensity 
had been manifested by 105 out of the total number 
of 619. 

IV. Monomania. — Monomania, properly so termed, is Monomania. 
a form of Insanity, which, from the attention given to it, 
might be supposed to be of more frequent occurrence 
than it really is. The term is professedly given to cases 
in which the intellectual faculties are unimpaired, except 
with relation to some particular topic. Instances, indeed, 
are continually occurring in which some particular im- 
pression of a delusive and insane kind, occupies the atten- 
tion of the patient and is uppermost in his mind, but 
unless the power of reasoning correctly on subjects un- 
connected with the illusion, is retained, the disorder is 
not a case of Monomania, or " Partial Insanity." 

A frequent illusion of Monomaniacs is, that they hold 
conversation with supernatural beings. 

In most instances of Partial Insanity Melancholy 

* It is remarkable that the excess of suicidal cases prevailed in the 
pauper part of the establishment. Thus, in forty-two cases of Melan- 
cholia, occurring among private patients, there were only eighteen 
suicidal cases, while in seventy-six among the paupers, forty-six 
were suicidal. 



108 

connects itself with the subject of delusion. These cases 
properly belong to Melancholia. 
Moral Ineanity. V. Moi'al Insanity. — This term is used to designate 
a form of mental disease in which the affections, 
sentiments, habits, and, generally speaking, the moral 
feelings of the mind, rather than the intellectual 
faculties, are in an unsound and disordered state. 
The common distinctive character of all these cases is 
of a negative kind, viz. — that the faculties of the under- 
standing remain apparently imimpaired, and that no 
delusive impression can be detected in the mind of the pa- 
tient, which may account for the perversion of his moral 
dispositions, affections, and inclinations. Cases of this 
description were formerly looked upon as unaccountable 
phenomena. They are, however, now recognised as a 
distinct form of mental disorder in nearly all the public 
Asylums. They are characterized by a total want of 
self-control, with an inordinate propensity to excesses 
of various kinds, among others habitual intoxication. 
This is often followed by an attack of Mania, which, 
however, speedily subsides when the patient is con- 
fined, but is generally reproduced, by the same exciting 
cause, soon after he is discharged. 

Among the Female Inmates of Asylums, there are 
many whose disorder principally consists in a moral per- 
version connected with hysterical or sexual excitement. 
Congenital VI. & VII. Congenital Idiocy, and Congenital 

gerdtel T be"" Imbecility. — Congenital Idiots are persons whose intellec- 
cility- tual faculties have never been developed. 

Congenital Imbecility is the result of some original 
defect, which renders the mind feeble in all its opera- 
tions, though not altogether incapable of exercising them 
within a limited sphere. There are many degrees of 
Imbecility, but the examples chiefly found in Lunatic 
Asylums are persons labouring under this weakness in 
an extreme degree. It is evident tliat more discrimi- 
nation ought to be used than has hitherto been practised 



109 

in solecting from persons of this class proper objects for 
confinement. 

VIII. General Paralysis of the Insane^ and other General Para- 
forms of Paralysis complicated with Insanity. in^sane 

Paralysis is not unfrequently complicated with In- 
sanity, and is almost an invariable indication that the 
case is incurable and hopeless, marking the existence of 
organic disease in the brain. 

In some instances, Insanity is the consequence of an 
attack of apoplexy, or of hemiplegia. This happens 
more especially in aged persons. 

In others, apoplexy or paralysis supervenes on pro- 
tracted mania or dementia. 

The most strongly marked case of the complica- 
tion of paralytic symptoms with those of mental 
disorder, is the disease termed General Paralysis of the 
Insane. This is more properly to be considered as an 
affection distinct both from ordinary paralysis and from 
insanity. The paralytic symptoms in this affection 
are sometimes observed to precede those of mental 
disturbance ; and others they follow. General paralysis 
of the Insane seldom occurs in females, but mostly 
in men, and is the result almost uniformly of a 
debauched and intemperate life. Its duration is 
scarcely ever longer than two or at most three years, 
when it generally brings its victim to the grave. The 
onset of the disease is distinguished by an impediment 
in the articulation, an effort is required in speaking, 
and the words are uttered with a sort of mumbling, 
and stammering. At this period, there is no other 
perceptible sign of paralysis, and the mobility of the 
limbs is not at all impaired. In a second stage, the 
patient is observed to have a tottering gait : the limbs 
are weaker than in health, especially the lower extre- 
mities, while the functions of the organs of sense are 
likewise enfeebled. In the progress of time, a third 
stage appears, during which the victim of this malady 



no 

loses not only the power of locomotion, but can 
neither feed himself nor answer the calls of nature. He 
becomes more and more weak and emaciated, but 
generally perishes under some secondary disease, such 
as gangrene, sloughing of the surface of the 
body, or diarrhoea, unless he be cut off at an earlier 
period by an apoplectic or epileptic attack, to which 
these patients are very liable. The disorder of the mind 
is peculiar in this affection. It is generally a species 
of monomania, in which the individual affected fancies 
himself possessed of vast riches, and power. 

This specific form of Insanity has been known for 
some time in France, by the Physicians of which coun- 
try it was first described : its existence has been more 
recently recognised in the English hospitals, and some 
instances of it are reported in the enumeration of cases 
transmitted from most of the County Asylums. The 
proportions which these cases bear to the whole num- 
ber of admissions is very different in different Asylums; 
as will appear by reference to the following Table : 

CASES OF GENERAL PARALYSIS. 

In 213 admissions into Han well Asylum, . 32 
In 120 „ „ Surrey . .16 

In 619 „ „ Lancaster . . 13 

Epilepsy. I^- Epilepsy. — In most of the Lunatic Asylums 

there are some, and in the large Asylums many persons 
confined among the insane who are subject to epilepsy. 
For this disease, unfortunately, is often complicated 
with insanity. There are, however, some Epileptics 
in these Asylums who are not insane, or in any way 
disordered in mind during the intervals of their 
paroxysms. 

Epilepsy is complicated with defects or disorders of 
the mind, in various ways. 

Epileptic Idiots. !• Epileptic Idiots. — Persons whose intellectual facul- 
ties have never been developed. They are not mate- 



Ill 

rially different, as regards their mental deficiency, from 
idiots not subject to Epilepsy ; but they require greater 
care, on account of the accidents to which this disease 
renders them liable, 

2. Epileptics who are imbecile or demented. — When imbecile or 
paroxysms of Epilepsy are very frequent and severe, and p"^.^"'^<l P^" 
the disease is of long duration, it generally impairs the 
intellectual faculties. Torpor, weakness and imbecility 

come on, which, if the patient survives under his dis- 
ease for many years, terminate in fatuity, similar in every 
respect to the fatuity which ensues in protracted Mania. 

3. Epileptic Mania. — Some persons subject to severe Epileptic Mania, 
paroxysms of Epilepsy without suffering obliteration of 

their intellectual faculties, and even without obvious dis- 
order of the mind during the intervals of their paroxysms, 
are nevertheless subject to occasional fits of a maniacal 
character. It is an observation frequently made by the 
attendants of Asylums, that when the Epileptic fits are 
coming on, such persons are irritable, morose, malicious, 
and sometimes exceedingly dangerous. During these 
periods. Epileptics are prone to violence, and sometimes 
perpetrate the most atrocious acts. Many instances are 
upon record of such persons, at a time when their dis- 
order had been in abeyance, or even supposed to have 
ceased altogether, having been seized with a sudden 
impulse to commit homicide, infanticide, suicide, or to 
set fire to houses.* In other instances, the mental 
disorder of Epileptics has the form of acute mania, or 
rather of raving' delirium. The patient, generally a 
day or two after the attack of Epilepsy, sometimes 

* Shortly before the second visit of the Metropolitan Commissioners 
to the Asylum at Gateshead Pell, a man had escaped, who it was 
thought had become nearly convalescent, and who was accordingly 
employed in the grounds belonging to the house. He was apparently 
so far recovered, that the Parish Officers (without reference to the 
Medical Visitor) determined to leave him at large. On the third night 
after his escape, he murdered his wife and daughter. His case was one 
of epileptic mania. 



112 



Epileptics 
whose intellects 
are unimpaired. 



immediately after It has ceased, is seized with a sudden 
fury, during which he sings, roars, shrieks, or resembles 
a man in a violent fit of intoxication. The species of 
madness which is complicated with Epilepsy is one of 
the most mischievous and dangerous forms of the disease. 
But the instances of this affection bear a very small 
proportion to the cases of Epilepsy in general. 

A great number of instances of Epilepsy, however, are 
well known to exist without any considerable disorder 
of the mind. Persons subject to occasional paroxysms, 
or those of infrequent occurrence only, are, during the 
intervals, in a tolerably perfect possession of their intel- 
lectual faculties, and are capable of following their 
ordinary pursuits. 

Adult persons of this description are scarcely to be 
found in Lunatic Asylums, but we have been informed 
that boys and girls, when they have become a source of 
anxiety and trouble to their parents, as well as danger- 
ous to themselves, have sometimes been sent by Boards 
of Guardians to Asylums for protection. We do not, 
however, consider this a sufficient reason for associating 
this class of epileptics wdth the Insane. Where a pro- 
per classification exists, the Epileptics are placed in 
wards by themselves, or are separated from the insane ; 
but there are many Lunatic Asylums where this regu- 
lation is entirely neglected. 

The proportion of Epileptics to the other inmates is 
very considerable in some Asylums, as may be seen by 
the following statement. 





Numbers 

in 

House. 


Epileptics. 


M. 


F. 


Hanwell 

Bethnal Green . . . 
Hoxton House .... 
Lancaster .... 
York W. Riding . . . 

Kent 

Chester 


975 
562 
396 
611 
433 
249 
164 


80 
40 
24 
40 
23 
15 
12 


63 
19 
20 
23 
16 
14 
6 



113 

X. — Delirium Tremens. — Instances of Delirium Delirium tre- 
Tremens are occasionally, though not often, seen among 
inmates of Lunatic Asylums. The disorder is well 
known. It is the result of intemperance, and frequently 
supervenes on a fit of intoxication. It is named from 
the muscular tremor and agitation which accompanies 
it, and the peculiar affection of the mind, resembling 
the delirium of fever rather than the phenomena of 
Insanity. It is not a disease of long duration, but ter- 
minates, for the most part, in a short period, either in 
death or in recovery. Hence, there are comparatively 
few cases of this description in Lunatic Asylums. 

Medical Treatment. 

Having thus described the different forms in which Medical treat- 
Insanity manifests itself, we now proceed to consider i^ms considered 
the Medical Treatment to which the Patients confined 
in Lunatic Asylums are subjected. 

In our visits to these Asylums, both public and 
private, we have been careful to make inquiries as to 
the methods of medical treatment adopted by the pro- 
prietors or superintendents, or by those persons to 
whom the medical care of the patients has been confided. 
We have occasionally found some difl&culty in obtaining 
information on this subject. In soqae instances, we 
have not seen the medical ofiicers, and we have derived 
our information, in such instances, from the proprietors, 
superintendents, and the inmates of the respective 
Asylums. Yet, on the whole, we have obtained a 
tolerably correct knowledge of the state of these esta- 
blishments, with regard to the manner and degrees in 
which the resources of medicine are applied in them to 
the cure and alleviation of mental diseases. 

A great difference prevails, in this respect, in the Difference pre- 
different classes of Lunatic Asylums. The licensed ""^f""^ 7 ^'^"" 

•^ ent Asylums. 

houses, containing fewer than 100 patients, in which the 

residence of a Medical Officer is not required, by the 



114 

Act 2, 3, Will. IV. cap. 107, within the walls of each 
Establishment, and which, in some instances, are linder 
the management of persons entirely without medical 
education, are visited generally by medical practitioners 
in the neighbourhood. These visits to the Asylums are 
usually made twice in a week, and in some instances 
more frequently. 

In some Asylums, the whole system of management 
appears to have been constituted less with regard to 
the cure of insanity, and to the restoration of lunatics 
to health and society, than to their seclusion and safe 
custody. Occasional doses of medicine are administered, 
when incidental deviations from bodily health or any 
contingency calls for their use, but the application of medi- 
cine and other restorative means, on any determined 
plan, with a view to promote recovery, and to restore 
the mental faculties to a sound state, appears in some 
Asylums never to have been contemplated. To accom- 
plish this object, the residence of a Medical man on the 
spot, or in the immediate vicinity, is very essential ; 
and here we cannot but notice the following extract from 
Report of Com- a Report of the Commissioners who visited the Norfolk 
Norfolk' Asy^ County Asylum in August, 1843, which will point out 
lum- the evils likely to be contingent on this arrangement. 

" The most serious defect in this Institution, and one 
"• which may be attended with the most mischievous, 
" if not fatal, consequences, is the want of a Resident 
" Medical Officer. On this subject, we cannot but 
" notice, as a singular anomaly in the law, that, whilst 
" it is required in every Licensed House, containing 
" 100 Patients, that there shall be a Resident Physician, 
" Surgeon, or Apothecary, there is no similar provision 
" as to County or Subscription Asylums, or public 
" Hospitals. The liability to apoplexy, and the pos- 
" sible occurrence of cases of suspended animation from 
" strangling may be mentioned as among the many 
" reasons calling for the constant attendance or immediate 



115 

" vicinity of a Medical man. We put some questions to 
" the Superintendent, as to what he would do in cases 
" such as we have described. His answer was that he 
" would not venture upon the responsibility of acting or 
" applying remedies, that he could not bleed, and had 
" no knowledge or experience, medical or surgical. 
" Upon asking, then, what steps he would take in 
" such cases, we were told that he would immediately 
" send to Norwich, the nearest place, three miles dis- 
" tant, for one of the Medical visitors. He subsequently 
" directed our attention to a pony on the lawn, 
" which he informed us was constantly ready to be 
" saddled as occasion required." 

It must be observed, that of several private Asy- General charac- 
lums the proprietors are physicians, who reside within ^^r of Medical 

1 • 1 T 1 T\ir CI ^^"^ attached 

their own establishments. Many of them are able to Asylums. 
and well-informed men in their profession, and ap- 
pear to treat their patients with judgment and skill. 
Many of the Superintendents of County Asylums, and 
some of the Medical Officers in those licensed houses 
which, from their containing one hundred patients 
require the residence of such an attendant, are men 
intelligent, and active in doing all that is practicable 
towards the restoration of their patients. 

The Medical Officers residing in the Asylums have 
been led by personal observation and experience, nearly 
to the same conclusions, as to the most efficacious treat- 
ment of Insanity; or, to speak more precisely, of adminis- 
tering the aids of medicine and regimen to those classes 
and descriptions of persons who are principally the 
inmates of public Lunatic Asylums. Amongst the Causes of In- 
most frequent causes of Insanity in Paupers, are ^'^^^^7 ^'^ P^"- 
habitual intemperance, poverty and destitution, grief, 
disappointment; and, we fear, in some instances want 
of sufficient sustenance. These causes act with dif- 
ferent degrees of influence on different individuals, 
according to the various states of their constitution, 
i2 



116 

but they have all a tendency to bring the body 
into a state of weakness and exhaustion. This is 
greatly aggravated by the insane poor being very 
generally sent in the first place to workhouses and 
other improper receptacles, instead of to Asylums, where 
they might be immediately subjected to medical 
treatment, at a time when the disease is known to be 
curable in a large proportion of cases- 
Curative treat- ^^ ^^ ^^^ general opinion of the best-informed medi- 
meut of Pauper (,^1 attendants on Lunatic Asylums that the most' 

Lunatics. 

successful method of attempting the cure of pauper 

lunatics in public hospitals, exhausted and destitute as 
they often are, is to obviate the state of body which 
poverty and distress have a tendency to induce. This 
is best effected by a restorative plan, and by means 
calculated to reproduce a vigorous state of bodily health. 
For this purpose a nutritive and tolerably full diet is 
allowed, consisting of a considerable proportion of 
animal food, wholesome digestible bread, milk porridge, 
or milk thickened with various farinaceous substances, 
and good broth. To these a moderate quantity of malt 
liquor, ale, or porter, is added in most cases, and in 
some extreme instances, wine and other stimulants. 
Warm clothing and bedding, and a moderately warm 
and dry atmosphere, are indispensable auxiliaries for 
promoting the comfort and cure of lunatics, in whom 
the circulation is languid, and who for the most part 
are chilly, and suffer much from exposure to cold and 
damp air. Exercise in the open air in cheerful airing- 
grounds ; baths, either warm or cold, according to 
the state of the circulation and the habitual tempe- 
rature of the skin; frictions promoting cleanliness and 
dryness of the surface of the body, and tending to keep 
up the action of the blood-vessels to a certain healthy 
standard, are generally found to promote the restora- 
tion of patients whose cases are of a curable descrip- 
tion. 



117 

The whole of this plan is said to prove beneficial 
only in those cases which are free from the ordinary 
signs of congestion in the brain, and from tenden- 
cies to epilepsy and paralysis. When these exist, 
they must be treated by appropriate remedies, such as 
topical bleedings and counter-irritations. In the cases 
before alluded to, tonic and stimulant medicines, and 
all the remedies which promote healthy digestion and 
a due circulation of blood to the extremities, are said to 
be productive of beneficial results. The tonic remedies 
most in use are carbonate of iron, cinchona, sulphate of 
quina., gentian, combined with aloetics when required 
by the state of the natural functions, or with astringents, 
when, in cases of great debility and exhaustion, there 
is a tendency to diarrhoea, or dysentery. A moist 
or relaxed state of the skin, with cold extremities; 
a shrunk and shrivelled surface, with a livid and 
blotchy, or pale and yellow complexion and feeble 
circulation, are well known to frequently co-exist 
with insanity, and are especially noted in those cases 
which are the result of depressing agencies. In this 
state of the system, great advantages are said to arise 
from the use of carbonate of ammonia, given in fre- 
quent doses, and continued for a considerable time. 
Emetics and powerful purgatives are said to be rather 
injurious than useful, in the forms of disease now 
described, except where any temporary complaint in- 
dicates the necessity of having recourse to them. It is 
the testimony of the best-informed among the Medical 
Superintendents of Asylums, that the restoration of 
bodily health is frequently accompanied by a marked 

improvement in the state of the mental faculties. We Regulations as 

to treatment in 
must not omit the fact, that although a very general some Asylums 

agreement exists among the intelligent Medical Officers ^* ^a"fn<=e with 

° Ob general opmion ; 

of Lunatic Asylums, as to the most efficient method 
of treatment for the cure or relief of the class of 
patients above described, there are some remarkable 



118 

exceptions, and that the regulations of some Asylums 
are quite at variance with the general opinion. 

Diet. 

first, as to diet ; In the first place as to diet. We have remarked 
that nothing is more important than a sufficient and 
appropriate diet in the treatment of lunatics. It is 
indeed evident, that nothing can be effected vnthout 
an ample supply of proper food, in the restoration of the 
patients from that state of physical weakness and ex- 
haustion, which is the condition of the majority among 
the inmates of pauper asylums. 

It is worthy of remark, that in two of the County 
Asylums, viz. those of Middlesex and of Dorset, the 
diet of the patients was sometime since improved by an 
increased allowance of food, and that in both of these 
asylums, there was recorded after this alteration an 
increase in the number of recoveries. Complaints have 
been made of the too great use of broths and gruel : in 
consequence of which, at Hanwell, a meat dinner has 
been substituted for pease-soup, on one of the two days 
on which the latter was previously given. It has been 
suggested to us, that regard should be paid to the nature 
of the food to which the patient was accustomed before 
his confinement. 

In the private Asylums admitting pauper patients, 
there is considerable diversity with respect to the allow- 
ance of food. In many of these establishments (and 
this is the case even in some which are defective in 
other particulars), a tolerably good and liberal diet is 
furnished to the patients. In many asylums a fixed 
quantity of beer is furnished to the patients, and in all 
these asylums it is the opinion of the proprietors that 
this allowance is beneficial. There are other asylums 
where beer is allowed to those who will employ 
themselves chiefly in out-door labour. In many in- 



119 

stances no malt liquor is furnished to the patients : this 
is observable in many of the large asylums in the North 
of England. In the Asylum of Lincoln it was thought 
advisable, sometime since, by the Committee of Manage- 
ment, to increase the quantity of nutritious food allowed 
to the patients, as a substitute for fermented liquors for- 
merly allowed to the patients. In the Leicester Asy- 
lum we were informed that the diet was varied with re- 
gard to the different classes of patients ; a poorer or 
lower diet being laid down for the Epileptics and Incu- 
rables than for others. 

The supply of a sufl&cient quantity of proper food ap- proper diet an 

important aid to 

pears to us one of the most important aids towards the ^^.g ^j, rgHef • 
relief or cure of insanity. We have received assurances 
from various intelligent superintendents of Asylums, 
that this disease has been frequently alleviated, and 
repeatedly cured, solely by increasing the quantity of 
wholesome food. The want of food is considered by 
the Superintendent of the Lancaster Asylum to have 
been the exciting cause of insanity in many cases which 
have come under his care. In some private Asylums, 
where a low scale of diet prevails, the small sum 
allowed for each patient has been pointed out, by which 
it appeared that the proprietor of the Asylum would 
have been scarcely remunerated for a more liberal supply 
of food. It is our opinion that the amount of food 
allowed to pauper lunatics, and the rate of payment 
made for them in private Asylums, should be under 
the control of official visitors. The Dietaries of the 
Pauper Patients in the several county and principal 
other Public Asylums, and a selection from the Diet- 
aries of the private Asylums receiving Paupers, will 
be found in Appendix E to this Report. 

The next subject to be noticed is that of temperature, second, as to 
A • • T 11 • 1 1 •!• temperature. 

A most important aid towards the restoration of debili- 
tated Insane patients to bodily health, and therefore 
towards their ultimate recovery, is afforded by a pure, dry, 
and warm atmosphere. External warmth is required by 



1-20 

the general state of circulation and of the skin, in a great 
majority of cases, and patients are known to suffer 
much from being in a cold or damp atmosphere.* In 
the Lincoln Asylum the lower galleries were found 
cold at our different visitations, and we were surprised 
to observe, among the standing regulations of the Com- 
mittee of Management, an express prohibition to the 
admission of heated air, although in the galleries no 
means existed of raising the temperature to a proper 
degree. It was quite evident to us that much needless 
suffering must be occasioned to the patients by this pro- 
hibition. 

In some of the smaller private Asylums, the apart- 
ments are not only cold, but extremely damp. These 
defects are calculated to occasion the prevalence of 
diarrhosa, dysentery, and pulmonary complaints, which 
are among the most frequent causes of death in Luna- 
tic Asylums. 

Meaus of exer- The means of exercise in the open air are very defec- 
tive in many of these Asylums. Even where there are 
extensive pleasure-grounds around the houses, pauper 
patients are in some instances prohibited from availing 
themselves of these advantages, and are shut up in small 
and cheerless yards. 

Use of opiates in The utUity of opiates as a remedy in cases of insanity, 
is a question on which we have found some diversity 
of opinion among the Medical Superintendents of Lunatic 
Asylums. Some abjure the use of all narcotic medi- 
cines, while others look upon sedatives as a most valu- 
able resource in cases of agitation and excitement, and 
have recourse to them on all occasions, when want of 
sleep and restlessness produce debility and exhaustion. 
This last practice seems to be gaining ground. Prepa- 
rations of opium and other sedatives, given in repeated - 
and sufficient doses, are thought by the best-informed 
practitioners, who conduct the medical treatment in 

* This subject is adverted to farther ia the section on Warming and 
Ventilation. 



cue. 



Insanity. 



121 

the large Asylums, to be of great efficacy in subduing 
excitement and agitation, and conjoined with the 
use of baths, cold applications to the head, and the 
use of anti-spasmodics and aperients, are said to 
promote the cure of Mania in the early and acute 
stages. Several instances are recorded, at the Licensed 
Houses of Bethnal Green, of Patients having been 
restored to reason, in a, very short time, by the skilful 
administration of opiates. The Committee of Manage- 
ment of the Lincoln Asylum, among other regu- 
lations for the guidance of their Medical Officers, have 
established the following rule, — that " the process of 
" subduing violence by the use of tartarised antimony, 
"or of narcotics, the practice of enforcing sleep by 
" opiates and courses of drastic medicines, are hereby 
" interdicted, except in special cases otherwise medically 
" requiring the same." 

The foregoing remarks upon the medical treatment 
practised in various Asylums must be understood to 
apply principally to recent cases. In chronic forms of 
the disease, although medicine alone is found to be of 
less efficacy, much is stUl accomplished by skilful 
medical superintendence, combined with judicious moral 
treatment. 

Pursuant to the Act 5 & 6 Vict. c. 87, sect. 8, Medical treat- 

. , T 1 . . ment not sub- 

we have inquired whether any medical treatment stituted on 
was in any of the Asylums substituted for coercion, coercion. 
It has been reported to us that no such system prevailed 
in any of the Asylums: but that the use of emetic 
tartar, of sedatives combined with aperients, and cold 
applications to the head in recent cases of high excite- 
ment, has occasionally rendered mechanical restraint 
unnecessary. 

Classification of Lunatics. 

One of the most important ameliorations, introduced Classification of 
. . - , . . Lunatics. 

during late years into the treatment of the insane in 

Lunatic Asylums, consists in the proper classification 



122 



Most beneficial 
in curable, re- 
quisite in incu- 
rable cases. 



Separation of 
dangerous Lu- 
natics from 
others. 



and distribution of patients into different departments. 
In former times the inmates of these houses, if not 
confined in solitary cells, were seen crowded together 
indiscriminately ; tranquil, and often timid and sensi- 
tive patients being assembled in the same apartments 
with violent and noisy maniacs. If any classification 
existed, it was little more than a separation of per- 
sons according to their various grades in society ; 
the poorer classes being divided from those who, by 
reason of larger payments, were considered to be entitled 
to greater personal comforts. The classification of 
lunatics, now generally adopted in well-regulated 
Asylums, is founded on a different principle. It consists 
in the distribution of patients with reference to their 
mental disorders, and in associating those persons whose 
intercourse is likely to be mutually beneficial, and in 
separating others who are in a state that renders their 
society a source of mutual irritation and annoyance. 

The distribution of lunatics, on this principle, is found 
to have a most beneficial influence in promoting their 
recovery, when their cases admit the hope of cure, and 
in incurable cases it is equally requisite, with a view to 
the personal security of the patients, as well as their 
comfort and tranquillity. The rules desirable to be ob- 
served, in order to obtain the most advantageous system 
of classification, have been mainly founded upon experi- 
ence. They have been, as yet, carried into effect by no 
means sufficiently or generally in Lunatic Asylums. 
This has been abundantly manifest to us in our visits 
of inspection. We shall endeavour to point out 
to your Lordship the several advantages and defects of 
these Institutions, in the particular to which we have 
now adverted, and to show how far the arrangements 
adopted in them answer to the requisite conditions of 
a complete and proper system of classification. 

The first object is the separation of dangerous Luna- 
tics from others. Wherever a considerable number of 



123 

Lunatics are assembled, there are found some who are 
subject to paroxysms of violent excitement, during 
which they are apt to assault other patients, or any 
persons within their reach. Others who are more 
dangerous, suddenly and without any previous sign of 
mischievous intention, inflict serious injuries, on slight 
provocation, or without any apparent motive, or they are 
prone to set fire to houses, and display various destruc- 
tive and malicious propensities. These persons would 
be sources of perpetual danger and alarm, and would 
sometimes occasion serious calamities if they were left 
at large in the midst of other patients, without being 
carefully watched. It is desirable for the complete 
security of the rest, to keep such dangerous persons, as 
far as practicable, in one or more separate divisions, 
where they may be surrounded by a sufficient number 
of vigilant and experienced attendants. There is in 
this particular a deficiency in many Lunatic Asylums 
which we have visited. 

In the second place, restless, noisy, and agitated Noisy Patients. 
lunatics, who would annoy and irritate the more 
tranquil, by shouting and screaming, require on this 
account, separate wards and airing grounds, removed 
as far as possible from the places appropriated to 
patients of a different description. Where these 
arrangements have not been adopted, which is the 
case in many of the private and in some of the public 
Asylums, the presence of noisy and turbulent maniacs 
is a source of perpetual irritation to the quiet patients ; 
and it must tend materially to aggravate their disorder, 
and in many instances to retard or prevent their recovery. 
We have particularly noticed the inconveniences arising 
from the absence of adequate means for separating the 
noisy from the tranquil patients, in our visits to the 
public Asylums at Lincoln, Suffolk, and in the licensed 
houses of Hoxton, Box, and Bailbrook House. The 
defect now pointed out occasions great disquiet, and an 



124 



Dirty Patients. 



Ill effects of 
want of such 
separation. 



Melancholic 

Patients especi- 
ally affected. 



Treatment of 

Suicidal 

Patients. 



appearance of restless agitation through the whole of 
those establishments. 

A separate department is obviously required for that 
class of patients, a very numerous one in many Lunatic 
Asylums, whose state or conduct is such as to render 
them disgusting and offensive to others. Fatuous per- 
sons or those who have sunk into the last stage of 
Dementia, and who are insensible to the calls of nature, 
are of this description. In most of the Lunatic Asy- 
lums of which the extent is sufficient to admit of an 
adequate separation of patients from each other, atten- 
tion has been paid to their comfort in this particular, but 
we have in some instances had occasion to observe great 
disquietude arising from the want of such an arrange- 
ment, particularly at Lainston House, Bailbrook House, 
and the private Asylums at Derby and Plympton. It 
is right to state that the present proprietor of the 
Derby Asylum, is about to discontinue the Pauper part 
of his Establishment. 

Melancholy or dejected patients often retain sufficient 
power of observation and reflection to render them aware 
of the state of others, and of their own condition, and they 
contemplate with horror the prospect of being reduced 
to the miserable plight of demented persons, or violent 
maniacs, when they are associated with such patients as 
they often are in Lunatic Asylums. On this accountmelan- 
cholics suffer more than any other class of insane per- 
sons from confinement in ill-regulated Establishments, 
Patients labouring under Melancholia, on account of 
the frequent instances of a suicidal tendency which are 
known to occur among them, require greater vigilance 
than any other description of persons. The classification 
of these patients calls for much care and discrimination. 
Their despondency would be aggravated if they were 
placed in the same apartments with individuals whose 
intellects are more deeply injured. They occasionally 
derive benefit from the comparison and contrariety of 



125 

tlieir several illusions, and some melancholies are cheered 
by being associated with patients of a lively and ex- 
citable habit of mind. In the Lancaster Asylum, the 
suicidal patients are associated with the cheerful, and 
this arrangement appears to be judicious, and attended 
with advantageous results. During an entire year, no 
actual instance of self-destruction had occurred, though 
there were upwards of a hundred cases in that Asylum 
in which a suicidal tendency had been ascertained to 
exist, and though no individual had been subjected to 
personal restraint.* 

There are many reasons which point out the impro- Separation of 
priety of keeping persons subject to attacks of epilepsy in patients. 
the same apartments with the other inmates. The 
sudden paroxysms to which these patients are liable 
are very distressing and alarming to timid persons, such 
as are many of those who labour under the less severe 
forms of insanity. On the other hand, the frequent 
noises and causes of excitement which happen in wards 
inhabited by maniacs, with whom epileptics are often 
placed, are very injurious to the last-mentioned patients, 
whose state requires that they should be kept free from 
all disturbance and sources of irritation. In reference to 
epileptic, and also to suicidal patients, an arrangement Arrangement 
is adopted in the Lincoln Asylum, which we have ^ ?^^^ 1"^ ^°" 

'■ •' ' com Asylum. 

observed in no other institution, but which we think 
deserving of imitation. These patients are placed in 
dormitories, where they are constantly watched through- 
out the night by an attendant, who sits up and is so 
placed as to have a complete view of the apartments in 
which the patients sleep. 

Another class among the inmates of Lunatic Asylums 

* It must be noted that four instances of suicide had occurred 
during the preceding year within a short time, a fact which had been 
attributed by the Superintendent, principally to the temptation and 
opportunity occasioned by the existence of iron bars in the patients' 
rooms. 



126 

Separation of are the tranquil and convalescent patients. In this 
convalescent department all those persons may be placed who, though 
patients. insane, are capable of conducting themselves quietly, 

and occasion no annoyance to others. 
Deviations from Deviations from the above method of separating 

rule to 1)G deter" 

mined by cir- patients, are occasionally introduced with advantage, 
cumstances. ^y mixing individuals of one class with those of a 
different description, when the particular state of such 
patients is likely to be improved by that arrangement. 
The propriety of such deviations from a general rule 
must be determined by particular circumstances. It 
will be seen that a somewhat mixed classification has 
been adopted in the Lancaster Asylum. 

We have not thought it necessary to specify aU the 
instances in which we have found classification imper- 
fect. These may in a great degree be collected from 
the other parts of our Report, in which the excess of 
restraint, and the defective construction of Asylums, 
have formed the subjects of particular animadversion. 
Classification in The method of classification adopted in the Lancaster 
lum the most Asylum, is the most complete of any that has fallen 
complete. under our observation. The outline of this is subjoined. 



LANCASTER COUNTY ASYLUM. 

clAkSSification and number op attendants before and since 
the system of non-coercion was adopted. 

On each side of the Establishment are ten Wards. 

1. Cases of Dementia, associated with active, orderly, 

and quiet cases, who have been some time in the 
house, and are capable of rendering assistance to 
the cases of Dementia. 

2. Recent cases, associated with the orderly, active 

and quiet cases of longer standing. 

3. Patients who have not manifested a tendency to 

violence, to the commission of suicide, or to escape 
from the Establishment. 



127 

4. Convalescent cases, a few old cases, and one or two 

suicidal cases. 

5. Refractory and excited cases. 

6. Suicidal cases, associated with cheerful and watchful 

cases. 

7. Refractory Patients, and violent Epileptics. 

8. Epileptic Patients who are not violent. 

9. Aged quiet cases, who have been a considerable 

time in the Establishment, and a few suicidal 
cases. 
10. Infirmary. 

The classification adopted in the Gloucester County Classification in 
Asylum is on a more simple plan, and it seems to be Q^^^^^y ^gy. 
productive of good efiects, since that establishment ^^^' 
presents the appearance of comfort, tranquillity, and 
good management. Excepting in what regards the 
separation of epileptics — an arrangement, as we have 
remarked, not firequently met with elsewhere — the system 
of the Gloucester A§ylura may be considered as a fair 
specimen of the classification adopted in County 
Asylums. The patients are there distributed as follows : 
one class consists of quiet patients and those approach- 
ing to convalescence ; a second comprises the epileptics ; 
a third, the fatuous patients; a fourth, the dirty and 
noisy ; and a fifth, the working class, forming a distinct 
body, which varies in number, and consists of the con- 
valescents, and of some incurable patients, who, how- 
ever, are capable of employment, and are occupied in 
cultivating the garden and grounds. 



128 



IV. 



OCCUPATION, AMUSEMENTS, AND EXERCISE. 



Beneficial ef- 
fects of occupa- 
tions and 
amusements. 



By the Acts 2 & 3 Will. IV. c. 107, s. 37, and 5 & 6 
Vict. c. 87, ss. 10^ 34, we are directed to inquire what 
occupations and amusements are provided for Insane 
Patients; and (by the latter Act) to state the eflfect 
thereof, in-door and out-door respectively. 

The answers which we have received to our inquiries 
have been generally, that occupations and amusements, 
especially such as take place in the open air, are beneficial 
to the bodies as well as to the minds of the Patients. 
Indeed, all intelligent persons who are well acquainted 
with the disease of Lunacy, by having seen it in its dif- 
ferent stages and varieties, and can therefore form some 
opinion as to the chance of its relief or ultimate cure, 
are strenuous in advising that insane patients should 
be employed as much as possible. From the observa- 
tions which we have been enabled to make on the 
subject, in the course of our visits through the several 
public and private Asylums of this country, we are 
disposed to concur fully in this opinion. It appears to 
us that employment should be afforded to all patients, 
whether pauper or private ; and that they should be 
induced to occupy themselves as much as is consistent 
with their bodily health : not, however, with the view 
of deriving any profit from their labour, but solely for 
the purpose of relief or cure. There can be little doubt 
but that by amusing the mind of a patient, and diverting 
his attention from any idea, either painful or delusive, 
which occupies it, that much good may be effected. 
The longer a delusion is dwelt upon, the stronger and 
more inveterate it becomes. It is important, therefore. 



129 

that it should be displaced (though only for a time) 
as soon as possible, by a fresh and healthy train of 
thought, and by occupations which may improve the 
patient's bodily condition, with which his state of 
mind is often connected, especially in the early stages 
of insanity. Employment^ therefore, in cases of long 
standing, tends to the tranquillity, and in recent cases 
contributes materially to the recovery, of the patient. 

In most instances, it is desirable to place at the 
disposal of the patient, the same species of occupation 
that he has been accustomed to follow, previously to 
his entering the asylum ; and if he has not been 
brought up to any profession or trade, it may be even 
proper that he should be instructed in some regular 
pursuit, in order fully to engage his attention. It is at 
all times important, that as much exercise and employ- 
ment as possible, in the open air, should be afforded, and 
that for this purpose, gardening and agricultural labour 
should be provided. 

Without reference, however, to any pecuniary advan- Labour of 
tage that may result to the rate-payer, or to the proprie- vf '^°v ^°i *" 
tor of the Asylum, we deem it most necessary that em- as a source of 
ployment should be provided for the lunatic. In fact, the 
labour of a Patient neither can, nor ought to, be reckoned 
upon as a regular source of profit. In the first place, it is 
uncertain ; depending upon his health, temper, and dis- 
position. A Lunatic, moreover, is a person afilicted with 
a positive malady, which frequently circumscribes his 
physical powers, and at other times exhibits itself in the 
shape of dangerous or violent excitement, suspending for a 
time, the capability of making himself useful. The object 
of employing a patient is not that he should make a return 
in value for the money expended upon him, but that 
his tranquillity and comfort should be promoted, and 
the disease with which he is afflicted, consequently 
mitigated or even removed. For this purpose, moderate 
labour only should be resorted to, and that as much as 

K 



130 



Spacious yards 
and pleasure 
grounds should 
be provided. 



Music, dancing, 
&c. 



possible in the open air, in order to strengthen without 
fatiguing the body; and it should be of such a nature 
as will afford amusement, without any risk of harassing 
the mind. 

With a view to these objects, spacious and cheerful 
vards, and also pleasure-grounds, should be provided, for 
the purposes of exercise, and of yielding the patient 
opportunities, at all seasonable times, of occupation and 
amusement in keeping them in order. But as^ by these 
means only, sufficient employment cannot at all times 
be afforded to any considerable number of persons, it 
seems necessary that a farm, or extensive gardens, 
(proportioned to the number of patients), should be 
attached to every large Asylum, and that a variety of 
in-door employments should also be provided. In order 
to promote exercise and occupation, it is also advisable 
that some trifling indulgencies should be given to such 
patients as are willing to perform a moderate quantity 
of labour. 

Music, dancing, and various games (as many as pos- 
sible in the open air) may be resorted to with advantage, 
in most cases, except where the patient is too exciteable. 
No Asylum should be without a library. Books, ju- 
diciously chosen, especially such as will not encourage 
any morbid ideas already existing, are an important 
help in promoting a happy and serene state of mind. 
In cases of great depression, and particularly of religious 
melancholy, books of a cheerful character should be 
placed, to a much greater extent than is generally done, 
at the disposal of the patients. In most of the Asylums 
that we have visited, we have found an abundance of 
religious publications, and in some few of them little 
else. However useful such works may be, we have fre- 
quently urged upon the various proprietors and super- 
intendents, the duty of their also procuring books and 
publications of an entertaining character, adapted to the 
capacity of the patients under their care. 



131 

In the better-conducted Asylums, these views are Provisions for 

• J 1 1 T-» 1 employment, 

apparently acted upon to a considerable extent. Books &c. in better- 
are procured and placed at the disposal of the patients ; conducted Asy- 
the exercise of trades and other in-door employments 
is encouraged, — in some cases rewarded ; and out-of-door 
occupation is provided by means of large gardens or 
farms, in which patients regularly labour in the proper 
seasons. 

In the Wakefield Lunatic Asylum, to which are In Wakefield 
attached a garden of three acres, and a farm of forty 
acres of land, we were informed (on our visit in Sep- 
tember, 1842) that 120, out of 208, male patients, and 
135, out of 190, female patients, were employed in various 
ways. These patients belonged to a manufacturing 
district, and occupied themselves in woollen and cotton 
weaving, and all the clothes, including the shoes, used 
throughout the establishment were made by the 
inmates. They made fancy articles also for sale, and 
performed all the gardening and agricultural labour. A 
variety of amusements was provided for them, and the 
effect both of occupation and amusement was considered 
to be highly beneficial. 

In the Kent Asylum, containing 253 patients, we Kent Asylum; 
were informed (September, 1843) that about half the 
patients of each sex were induced to work ; the men in 
gardening and field-labour, and in cleaning the yards of 
the establishment; the women in knitting, sewing, 
washing, and household work. The land attached to 
this Asylum consists of thirty-seven acres, fourteen of 
which (laid out in gardens and airing-grounds) are 
inclosed by walls. 

In Dr. Warburton's Asylum, at Bethnal Green, Bethnal Green ; 
a library of very considerable extent has been purchased, 
from time to time, for the use of the patients, who are 
also encouraged to employ themselves in various ways ; 
some in making shoes, clothes, and mats; and others 
K 2 



132 



Dorset County 
Asylum ; 



Gloucester 

County Asy- 
lum ; 



Deficiency iu 
respect of em- 
ployment, &c. 
in many Asy- 
lums ; 



West Auckland; 



in the kitchen and laundry, and in needle and household 
work, and in and about the yards of the Asylum. 

In the Dorset County Asylum, (containing, in Octo- 
ber, 1842, 109 pauper patients), a considerable propor- 
tion are employed in the garden, laundry^ in plaiting 
straw, and in needle and household work ; and they are 
encouraged thus to occupy themselves by an extra diet. 
A few books, and various amusements, are provided for 
them ; and they are allowed to take exercise in the 
neighbouring fields. 

At the Gloucester County Asylum, besides the exten- 
sive and cheerful yards and grounds in the midst of which 
the buildings stand, there are twenty acres of garden 
ground without the walls, which are entirely cultivated 
by patients. On our visit to this establishment (in Sep- 
tember, 1842), a number varying from sixteen to twenty- 
six were thus employed, and a considerable proportion 
of the other patients were occupied in various ways, 
and always, according to the superintending physician's 
report, with beneficial efi'ect. 

But, in a considerable number of asylums, (not 
excepting even some of the county asylums) there is a 
great deficiency in respect to employment, and this 
deprives the lunatic of his fair chance of that benefit 
which these establishments were intended to afi"ord. It 
appears to us that no means of cure or relief should be 
left unattempted, in hospitals where the professed object 
is to restore to health all who are still susceptible of 
cure, and to relieve those who are incurable, as far as is 
practicable. ' 

At the "West Auckland Asylum, there was at our first 
visit only one, and there are now only two very small 
yards, (each measuring about twelve yards wide by 
thirteen yards long) for the thirty-one patients confined 
there. There is, indeed, half an acre of garden ground, 
and six acres of grass land, but these are available 



133 

only at certain seasons of the year for the purpose of 
employing the male patients. Very little exertion 
appears to be made at this asylum for the employment 
of any of the patients. They were all, with the excep- 
tion of one, unoccupied when we visited the place in 
August, 1843. Vfe saw no books, and no means of 
amusement. 

At St. Peter's Hospital, in Bristol, the only place St. Peter's Hos- 
where the female patients, forty in number, can take ' ' 

exercise, is a small passage or paved yard at one end of 
the hospital. It is, in fact, part of a lane or road, 
and is the only road through which carts and other 
carriages have access to the house. Upon the approach 
and return of every vehicle, the female patients are 
removed into the House, in order that the gates at each 
end of the road may be opened. It is right to state 
that every exertion has been used to render the place 
commodious, but this, from want of space, is quite im- 
practicable. 

At the Hilsea Asylum near Portsmouth, containing, Hilsea Asylum; 
in June, 1843 twenty -nine patients, there is one yard of 
tolerable size, for the male patients, adjoining the high 
road, and a small one at the back of the house, which 
appears, from its being overgrown with grass, to be 
little used, for the women. We could not ascertain that 
any of the patients occupied themselves, with the excep- 
tion of two or three of the women, w^ho, we understood, 
were occasionally employed in needle and household 
work. 

At the Leicester County Asylum, in which there were, Leicester 
in August, 1842, 117 patients, there are only three J,"^?'^ ^'^' 
acres used as garden ground and pasture, besides the 
yards attached to the buildings, which last are inclosed 
within high walls. 

At the Nottingham County Asylum, in which there Nottingham 

were, in Oct. 1842, 159 patients, there are good County Asy- 
lum; 



134 



Norfolk County 
Asylum ; 



Haverfordwest 
Asylum ; 



yards ; but the premises are nearly surrounded by 
adjacent buildings, and there are only a small garden 
and three acres of land (rented) to afford employment 
for the patients. Every endeavour, however, which the 
space will allow, is made to occupy them. 

At the Norfolk County Asylum, which contained, 
in August, 1842, 165 patients, there are less than five 
acres of ground, including the sites of the buildings. 

At the Haverfordwest Asylum, in the county of 
Pembroke, which contained eighteen patients (in 
September, 1842) there was no place for exercise, except 
two small yards, surrounded by walls ; and there was 
neither garden, pleasure-ground, nor field, to afford any 
opportunity whatsoever for the patients to employ them- 
selves. There were no books, nor any means of amuse- 
ment. The consequence was, that every patient in the 
Asylum was listless and unoccupied. Most of these, 
however, were apparently incurable. 
Hoxton House ; At Hoxton House, containing nearly 400 patients, of 
both sexes, there are only yards — some of them, indeed, 
not deficient in space, but surrounded by high walls, and 
(partly) by adjacent buildings, — for the purpose of 
exercise. Being in the suburbs of London, there are 
no means, of course, except at a very great expense, 
of obtaining any considerable quantity of additional 
ground. 

The land immediately attached to the Lancaster 
Asylum, where there were, in October, 1842, 621 
patients, then, and until recently consisted, of five statute 
acres, including the sites of the buildings and ofi&ces. 
There were also ten acres (separated from the Asylum 
by a public road), which are cultivated as a farm ; but 
the entire quantity of land vcas quite inadequate to pro- 
vide sufficient employment for so large a number of 
patients, many of whom belong to the agricultural class. 
This caused a considerable proportion of them to remain 



Lancaster Asy^ 
lum; 



135 

unoccupied. * The superintendent, appears to use his 
best endeavours to promote in-door employment^ in the 
shape of plaiting straw, household work, and the exern 
cise of various trades. 

At the Asylum, called the Eefuge, near Hull, in which Refuge, near 
there were (in September, 1842) 100 patients, there are ^"^^'' 
only yards of moderate dimensions for exercise. The pro- ' 
prietor has no land for agricultural purposes ; but there 
is a garden of some extent, in which the patients (the 
males and females alternately) take daily exercise, when 
the weather will permit. 

The Devonport "Workhouse, situate in the poorest Devonport 
and most populous part of Devonport, with narrow Workhouse; 
streets and high adjoining buildings on every side, is 
licensed as an Asylum for lunatics. But there is only 
a very small paved yard, in which the patients, amount- 
ing to twenty-three, can take exercise. It is quite in- 
sufficient for the purpose. The lunatic wards, however^ 
in this establishment, appeared to us to be under excellent 
management. 

At the Asylum at Duddeston (near Birmingham), ^s lum at Dud- 
there are extensive grounds, but the pauper lunatics, deston ; 
amounting to 60, (in January, 1844), are generally (if 
not always) confined within very small yards, quite 
insufficient for the purpose of exercise. 

The Bailbrook Asylum, near Bath, is situate on an Bailbrook Asy- 

eminence, but it is without the means of affiarding out- ^^'^• 

of-door labour to the patients, amounting to 94 in 

number, and almost all of the poorer class. — The yards 

at Kingsdown Asylum, near Box, in Wiltshire, 

where there is a large body of pauper lunatics, are 

small and bad, and quite insufficient for the purpose of 

exercise. 

We have selected the foregoing instances, in order to General re- 
marks. 
* The County Magistrates, as has been elsewhere stated, have 

lately added 30 acres to the Asylum, by purchase, under the powers 
of a Local Act. 



136 



Insufficient pro- 
vision for exer- 
cise in Work- 
houses. 



show the nature of the defects inherent in several of the 
Asylums; and in order also that previously to the 
future erection of any establishments (especially public 
Asylums), the subject may receive fair and full consi- 
deration. We are fully satisfied of the great value of 
occupation to the lunatic, and we think that no public 
Asylum should be sanctioned without first ascertaining 
that ample space exists, and that proper arrangements 
will be made, for carrying this desirable object into 
complete effect. 

We have not here animadverted upon the small space 
afforded to lunatics, for the purposes of exercise, in the 
various Workhouses wherein they are confined. In the 
Workhouse situate in the middle of the town of Bir- 
mingham, there were, in September, 1843, seventy-one 
insane patients of both sexes, and the only place allotted 
to eighteen of the females, was a yard, common to them 
and the other inmates of the Workhouse, in which they 
were permitted to walk from ten till eleven o'clock in 
the morning, and from three to four in the afternoon. 
The remainder of the patients, fifty-three in number 
(nearly thirty-three males and twenty females), took 
exercise in a confined court or yard, not more than sixty - 
six feet long by forty-five in width ; one corner (twenty- 
three feet by twenty) being railed off for the females. 
Both yards are surrounded by high buildings. In the 
other unlicensed Workhouses which we have seen, the 
space for exercise assigned to Insane poor, is generally 
less in proportion to their numbers, even than in those 
Licensed Houses to which we have adverted, as espe- 
cially deficient in this respect. 



137 

V. 

RESTRAINT. 



We are directed by the Act 5 & 6 Vic. c. 87, to inquire 
in every Licensed House whether any patient is under 
restraint, and why ; and to report whether there has been 
adopted, either in the whole or in part, any system of 
non-coercion, and the result thereof. By section 32, a 
similar report is required to be made as to every county 
Lunatic Asylum. 

In every licensed house and county Lunatic Asylum, 
and also in every public hospital, and other place con- 
taining insane persons, which we have visited, we have 
made minute inquiries as to the particulars of every 
person found under restraint, and as to the system 
adopted in the establishment in this respect. 

In some Asylums, both public and private, the super- General remarks 
intendents and proprietors state that they manage their jigugg of re- 
patients without having recourse to any kind of re- straint. 
straint whatever. In other Asylums, it is affirmed that 
the disuse of restraint is their rule and system, and that 
its use, in cases of necessity or expediency, forms the 
exception to the rule. Those who profess the entire 
disuse of restraint, employ manual force and seclusion 
as parts of their method of management, maintaining 
that such measures are consistent with a system of 
non- restraint. It is said by these persons that when any 
of the limbs (as the legs or hanils of a patient) are con- 
fined by the strait -jacket, the belt, or by straps or 
gloves, he is under restraint. But in cases where he is 
held by the hands of attendants, or when he is for any 
excitement or violence forced by manual strength into 
a small chamber or cell, and left there, it is said that 



138 

restraint is not employed, and the method adopted 
in these cases, is called " the non-restraint system." 
In those cases where the patient is overpowered by 
a number of keepers holding his hands or arms during 
a paroxysm of violence, it is said that there is no 
mechanical restraint. Here restraint of some sort or 
other is manifest ; and even in those cases where the 
patient is forced into a cell by manual strength, and 
prevented from leaving it until his fit of excitement shall 
have passed, it is difficult to understand how this also 
can be reconciled with the profession of abstaining from 
all restraint whatever, so as to be correctly termed ' Non- 
restraint.' It seems to us that these measures are only 
particular modes of restraint, the relative advantages of 
which must depend altogether on the results. — The advo- 
cates of these two systems, to which we have called your 
Lordship's attention, appear to have been actuated by a 
common desire to improve the condition of the insane. 
Those who employ, as well as those who do not employ 
mechanical restraint, adopt an equally mild and con- 
ciliatory method of managing their Patients. The usual 
forms of mechanical restraint are strong dresses, strait- 
waistcoats, gloves, straps or belts made of linen-cloth or 
leather. 

The Retreat, at The Retreat, at York, was established in the year 
York 

1796, and introduced a milder system of managing the 

insane, than any then previously practised. This ad- 
mirable institution has from its foundation up to the pre- 
sent time steadily pursued the same humane and bene- 
volent method of treating its patients with which it 
commenced, and Mr. Samuel Tuke, so well known in 
connexion with this Asylum, and who accompanied us 
iu going over it, said that no considerable change in 
regard to the system in use at the Retreat had re- 
cently taken place. 
Attention of lu the year 1828, the licensing and visiting of Houses 

Commissioners ^^j. ^j^^ reception of the Insane in the Metropolitan dis- 

directed to abo- -"^ -^ 



139 

trict was entrusted to this Commission; and we have since lition of le- 
that period constantly directed our attention to procure *''^'°'- 
the abolition of restraint, in all cases in which we have 
considered that its use could be avoided with benefit, 
and without danger, and to its modification and dimi- 
nution in those cases in which we have thought it to 
be still necessary. 

Whatever may be the means or forms of control Bodily restraint 
exercised over the persons of patients, or whatever the ?°^ permitted 

*^ jT 7 m well-managed 

degrees in which the application of this control may be Asylums, except 

111 6Xtl*6rDC 

varied in different Asylums, we have the gratification cases. 
of reporting to your Lordship that in every public and 
private Asylum in the kingdom, which is well managed, 
bodily restraint is not permitted, except in extreme 
cases, and under the express sanction of a competent 
superintendent. The unanimous opinion of the medi- 
cal officers and superintendents of these public and 
private Asylums is, that the diminution of restraint 
in the treatment of lunatics has not only lessened the 
sufferings, but has improved the general health and 
condition, as well as promoted the comfort of the 
insane. "We entirely concur in this opinion. 

Before noticing the distinctions that we have found Censurable 

in the different public and well-conducted Asylums, ^f^t^aint prac- 
tised in certain 
upon the subject of restraint, we feel it to be our duty Asylums. 

to direct your attention to that excessive and highly 
censurable degree of restraint, which we found in prac- 
tice at the licensed Asylums at West Auckland, 
Wreckenton, Lainston, Plympton, Box, Nunkeeling, 
and some other houses which we have elsewhere 
made the subject of especial notice. In the present 
state of some of these establishments, restraint is ren- 
dered more necessary than in a well-constructed Asylum, 
but all such places are, in our opinion, unfit for the 
proper care of the insane. With respect to th ese Asylums, 
in which the restraint in use has been so improper and 
unjustifiable, we hope that the day is not distant when 



140 

they will either wholly cease to be licensed for the recep- 
tion of insane persons, or will be put upon an entirely 
improved system in this and in other respects. 
Results of the The non-restraint system* appears to have been esta- 
system. blished at Lincoln in 1838, and to have been adopted at 

Han well in 1839, and at Lancaster in 1840. The 
same system has been in operation for some years in 
the Suffolk Asylum, and is now in practice at Glou- 
cester, and has been pursued at Northampton from its 
opening in 1838 ; and at the Haslar Hospital it had 
been in operation fifteen months at our visit in 1843. 
The superintendents of these Asylums have all steadily 
pursued this system since its introduction, and, as they 
consider, with great advantage to their patients ; but 
they still think that it is necessary to restrain the 
limbs during surgical operations. We found the Asylums 
at Gloucester, Lancaster, Northampton, and Haslar, 
very well managed, and their patients tranquil and 
comfortable and the superintendents of these Esta- 
blishments, consider that the comfort of the patients, 
and the general condition of the Asylums, have 
been improved since the adoption of this system. No 
inconveniences whatever have been experienced at 
Gloucester or Northampton. In the year ending the 
30th of June, 1842, there were four deaths by suicide at 
the Lancaster Asylum. The superintendent of this Asy- 
lum has stated that had mechanical restraint been in prac- 
tice in the Asylum, it would not have been resorted to 
in any of these cases, and that these lamentable events 
are not fairly to be attributed to the absence of such 
restraint. The present Medical Officers at the Lancaster 
Asylum have carried out the system of non-restramt to 
its fullest extent. By every expression of kindness, 
by appearing to sympathise in the patient's imaginary 



* By the non-restraint system is understood the system which does not 
employ restraint, by dresses, gloves, belts, or other similar coDtrivances. 



141 

sufferings, and by taking a deep interest in all his con- 
cerns, they endeavour to soothe morbid irritation, and 
thus allow an opportunity of restoring the healthy 
action of the mind. By this method, in several 
recent cases the Superintendent has been successful 
in curing the disease, or at all events in preparing the 
frame for the reception, and favourable operation of 
medicines, and other means calculated to promote a 
cure. We found unusual excitement prevailing in the 
disorderly ward on the female side of the Asylum at 
Lincoln ; and in one of our visits to Hanwell and at 
both our visits to the Suffolk Asylum, we witnessed, 
amongst the worst class of females, outbreaks of violence 
and excitement, which we have not met with elsewhere. 
At the Lincoln Asylum, a register of accidents and 
bruises, &c., is kept, which seem frequent. 

The system of non-restraint at Hanwell has been System at Han- 
carried on by mild and kind treatment of the patients, 
by an increase in the numbers of attendants, and by 
adopting seclusion or solitary confinement, sometimes in 
darkened cells, in lieu of mechanical restraint. At 
our visit to this Asylum in 1843, there was no patient 
under mechanical restraint ; but we saw a violent female 
lunatic, who had been endeavouring to bite other persons 
as well as herself, seized by four or five of the nurses, 
and after a violent and protracted struggle, forced with 
great difficulty into, and fastened in, one of the cells. 
During this scene, there was much confusion in the ward, 
and the great efforts of the patient to liberate herself, 
and (after her seclusion) the violence with which she 
struck the door of the cell, and threw herself against it, 
must have greatly exhausted her. In another case, a fe- 
male, secluded in a darkened cell, had contrived to tear 
off considerable quantities of a woollen rug, which she 
formed into balls and swallowed ; one of these stuck in 
her throat, and, but for prompt assistance, accidentally 
rendered at our visit, she might have been suffocated. 



142 

In another case, a female patient rushed against an elderly- 
female with all her weight, striking her at the same 
time violently on the loins, and precipitating her for- 
wards. The person thus struck, being quite unaware of 
the attack, fell forwards on her head and neck in such 
a way as to cause apprehension lest a dislocation of 
the neck might have taken place ; fortunately she did 
not receive any serious damage. Another woman was 
seen by us with the skin of her arm torn nearly from 
the wrist to the elbow, and bleeding from a severe cut 
which she had just received, by thrusting it through the 
window of the cell in which she was confined. Besides 
these acts of violence, we observed on the bodies of 
several other patients various cuts and bruises, which 
we were told had been inflicted by their insane com- 
panions, and which we rarely meet with in other 
Asylums. During the short interval between the first 
and last days of our visit to this Asylum in June, 
1843, one of the male patients was killed by another.— 
On our visit to HanweU in the year 1844, we found 
the Asylum in good order, and the patients, with one 
or two exceptions, tranquil and comfortable ; and not 
one under mechanical restraint. 
The Suffolk In the Suffolk Asylum, the patients, with the excep- 

^ "™' tion of those of the worst class of females, were tranquil. 

At our first visit, however, in the ward occupied by 
refractory females, and in the airing-court attached to it, 
there were a great number of violently-excited patients, 
who attacked^ abused, and struck at the other patients, 
and rendered the whole place a scene of distressing 
turbulence and confusion. At our second visit, the 
matron expressed a fear of the consequences, in the 
event of our going into the female refractory yard. 
"We found some of the Patients half naked, from 
having destroyed their clothes; one was, during the 
whole time we were in the yard, struggling with a 
nurse : two of the most violent were removed from 



143 

the yard before we entered it, and the fury of those 
who remained was excessive. 

We do not offer any opinion as to whether the acts 
of excitement and violence which we met with in the 
Lincoln, HanweU, and Suffolk Asylums, were the result 
of mechanical restraint being dispensed with. It is to be 
observed, that at the Lincoln and Suffolk Asylums, there 
is a great want of proper classification, to which the 
scenes which we witnessed were no doubt partly to be 
attributed. 

With respect to the public Hospitals and County 
Asylums which still occasionally employ mechanical re- 
straint, we found the following numbers of persons under 
such restraint at the periods of our visits. 

PUBLIC HOSPITALS AND COUNTY ASYLUMS USING 
MECHANICAL RESTRAINT. 



Want of classi- 
fication may- 
lead to excite- 
ment and vio- 
lence. 



Hospitals. 


II 


•s-Sg 


Hospitals. 




3 3 m 


Retreat, at York . 
York Asylum 
St. Luke's . . 


99 
159 
222 




1 
1 


Radcliffe . . , 
Liverpool . . . 
Exeter .... 


42 
73 

48 



1 
1 



Tabular view of 
numbers under 
restraint at 
Commissioners' 
visits 'to Public 
and County 
Asylums. 



County Asylums. 


lei 


II 


County Asylums. 


II 

§=3 


II 




^S 


4 




^8 


^i 


Bedford .... 


140 


Nottingham . , 


159 





Cbester .... 


157 


1 


Norfolk .... 


164 





Cornwall . . . 


147 





Stafford .... 


244 


1 


Dorset .... 


105 





Surrey .... 


344 


1 


Kent .... 


253 


1 


Wakefield . . . 


3,98 


in 


Leicester . . . 


114 


2 









At the Retreat, at York, at our first visit, one female Case of restraint 
was under restraint. She was sitting at table dining ^ *^® ^^*'^^^*» 
with the other patients, and had only one hand confined. 
Another patient was secluded in a room. At our second 
visit, no one was under mechanical restraint, and there 
had been no one so restrained for nine months. We 



144 



System of Re- 
straint at York 
Asylum, &c. 



Practice pur- 
sued in County 
Asylums. 



Restraint in Li- 
censed Houses. 



found the patients in the Retreat tranquil, cheerful, 
and clean, and apparently enjoying every comfort of 
which they were capable. 

The York Asylum, the Hospital of St. Luke, the 
Radcliffe (now the Warneford) Asylum), and the 
Asylums at Liverpool and Exeter, have for many years 
pursued a mUd system of treatment, and have not re- 
sorted to restraint except in cases of emergency, and 
under medical authority. Some of these Hospitals are 
more commodious and have better accommodations and 
conveniences than others, but in all of them we found 
the patients kindly and judiciously treated, and, as far 
as their circumstances would admit, comfortable. 

In the County Asylums, in which mechanical restraint 
is still occasionally resorted to, the system pursued is 
that of dispensing with it in every case, unless either 
the cure, or the security of the patient, or others, is con- 
sidered to render it necessary. The single patient found 
under restraint at the Chester Asylum was a most 
violent and dangerous maniac, who had been convicted 
of murder, and would, if at liberty, instantly attack any 
person near him, in the most savage manner. The 
only person under restraint at the Kent Asylum, in which 
was a large proportion of most violent female patients 
was a powerful and dangerous man, who is disposed to 
strike and injure the othar patients, and especially those 
who are not so strong as himself. At the Nottingham 
Asylum, when visited in 1843, no restraint had been used 
during the previous year, except in four cases, for surgical 
purposes. We have in general found the patients confined 
in these Asylums tranquil and comfortable. At the 
Wakefield Asylum there were ten patients under re- 
straint. This may be considered a large number : this 
Asylum, however, is in general very well conducted. 

We feel that it is more difBicult for us to convey to 
your Lordship an accurate view of the state of licensed 
houses, than of public Hospitals and County Asylums 



145 

in respect to the subject of restraint. There are ninety- 
nine licensed houses in the provincial districts, of which 
thirty-nine receive paupers ; and forty-three licensed 
houses in the Metropolitan district, of which four 
admit paupers. At the licensed houses at Denham- 
Park and Fairford, restraint is stated not to be employed, 
under any circumstances ; and these houses are both well 
managed. We were, however, sorry to see a female, in 
1843, at Fairford, permitted to gnaw her fingers into 
sores. The proprietors of almost all the best-managed 
Asylums for private patients, in the provincial and 
Metropolitan districts, employ restraint only in extreme 
cases. Although we believe that the two houses above- 
mentioned, are nearly the only Licensed Houses in 
which mechanical restraint is entirely suppressed, yet 
out of 60 Houses receiving only Private Patients in the 
Provincial Districts, we found, in 37 that there was 
not one person, and in 15 only one person in each, under 
restraint. In the Metropolitan District at our last visit 
in the year 1843, out of 32 houses receiving only Private 
Patients, in 22 there was not one, and in 6 we found only 
one under restraint. At the White and Red Houses of 
Dr. Warburton, at Bethnal Green (the one for males and 
the other for females) there are 575 patients, the larger 
part of whom are paupers, and many of the females are 
of the worst and most hopeless and violent class. In 
these houses, we seldom find more than one or two 
persons under bodily restraint, and in four out of our 
last eight visits, not one. At Hoxton, containing 
upwards of 400 patients, there are frequently eight or 
ten persons restrained : but in the present defective 
accommodations of this house more restraint is 
employed than would be necessary in a well- con- 
structed Asylum. 
Those who profess wholly, and those who profess in Seclusion or 

, . , ,. .,, 1. • i 1 1 • solitary confine- 

part Only, to dispense with restraint, employ seclusion or ^^^^' 

solitary confinement ; but the former resort to and advo- 

L 



146 

cate this mode of treatment more extensively than the 
latter. Seclusion or solitary confinement is now getting 
into general use in the treatment of the insane, and 
great numbers of the superintendents of public, and of the 
proprietors of private Asylums throughout the country 
are fitting up and bringing into use solitary cells, and 
padded rooms for violent and unmanageable Lunatics. 
Lincoln Asylum is the only place in which even seclu- 
sion is not resorted to. Seclusion (or solitary confine- 
ment) is found to have a very powerful efifect in tran- 
quillising, and subduing those who are under temporary 
excitement or paroxysms of violent insanity. As 
solitary confinement is coming into more general use, 
as a remedy in Asylums, and as persons who have 
been subjected to its operation for long periods, have 
become insane, we feel that we ought to notice the prac- 
tice so far as it may be employed in the treatment of 
lunatics. As a temporary remedy, for very short periodS;; 
in cases of paroxysms and of high excitement, we believe 
seclusion to be a valuable remedy. We are convinced, 
however, that it ought to be used only for short periods, 
and that it should not be permitted as a means of 
managing and treating those persons who are perma- 
nently violent and dangerous. Long solitary confine- 
ment of any person in a cell, is calculated to destroy his 
bodily health. 
Register should If Solitary confinement is to be employed in Asylums, 
soliirycTnfire- ^^^^7 institution, whether public or private, which 
meat employed, ^ges it, should be required to keep a register of every 
person who shall be in such confinement, and of the 
duration of every separate term of confinement. If it 
has been deemed necessary by the legislature to require a 
register of restraint, it is equally necessary, in our 
opinion, to have a register of seclusion or solitary confine- 
ment, which is more liable to abuse, and less capable 
of detection, than those means of bodily coercion, 
which are visible, and are in ordinary use. At Hanwell 



147 

this precaution has been wisely adopted, and was found 
in practice at our last visit, being required by the printed 
rules of the Asylum. It is obvious that seclusion, or 
confinement, with the limbs all at liberty, is not a pro- 
tection against the indulgence of certain dirty and dis- Dirty habits. 
gusting practices, which are very injurious and not un- 
common, but very difficult to overcome in the insane. 
Mechanical restraint has succeeded in some, but by no 
means in all cases, in removing them. At the Middlesex 
Asylum, it has been attempted to defeat dirty habits 
by the administering of aperients. At the Lancaster 
Asylum, good effects have been produced in obviating, 
and in many cases in entirely removing, such habits, 
by assiduously endeavouring to invite due attention to 
the calls of nature^ 

With a view to lessen the necessity for bodily coer- Means 
cion, we have enjoined, in the Metropolitan district, the ^ploy^d m 
division of patients into classes, and the separation of district to ob- 

,1 1 1 i ., , -i J. J viate restraint. 

those, whose habits or temporary excitement render 
them dangerous, from others who are irioffensive; we 
have also urged an increase of attendants on the former 
classes. We have further recommended the erection 
of separate rooms for the temporary seclusion, during 
short periods only, of those who are subject to 
paroxysms of excitement or violence. 

In the month of July last, we found, at Whitmore Danger of total 
House, a gentleman sitting in a room with a number '.^"f^ ° mecha- 

' ° o nicai restraint, 

of other patients, who had a short time previous illustrated by 
bitten the hand of one of the attendants, so as to cause 
serious apprehensions that it would have been necessary 
to amputate the arm. This patient had been secluded 
in a padded room some portion of the day on which we 
saw him, and at the time of our visit was unre- 
strained, but under the watch of two keepers, who 
were in the apartment for that purpose. The medical 
superintendent and keeper both stated that notwith- 
standing the precautions then in use, they were appre- 
l2 



148 

hensive of a similar injury being inflicted by him upon 
some other patient or attendant ; but in deference to 
the popular opinion on the subject, they did not apply 
mechanical restraint, although they thought that it was 
necessary. We recommended that bodily restraint should 
be employed. Shortly after giving this recommendation, 
we found at the Asylum of Mr. Scales, near Portsmouth, 
the widow of a former superintendent, whose hand had 
a few months previous been bitten by a dangerous 
patient, who was in the house at the time of our visit. 
The superintendent died from the effects of the bite, 
within twelve days after the injury. In the County 
Asylum, at Bodmin, we found two patients, one of 
whom had lost an arm, and another a thumb from 
amputation, in consequence of the bites of other patients. 

In the Asylum for the county of Dorset, we found a 
patient whose suicidal propensities were so determined 
that he had once attempted to drown himself, twice to 
hang himself, once to cut his throat, and also to choke 
himself by thrusting his sheets down his throat, and to 
strangle himself by twisting his handkerchief round his 
neck. The restraint of muffs was resorted to ; and, al- 
though previously restless and trying continually to get 
out of bed, this person began to sleep comfortably, and 
was, when we saw him, tranquil and apparently con- 
valescent. Restraint had only been used in six cases in 
this Asylum during twelve months. The particulars 
of four of these cases are unfit for publication. Of 
these six cases, three had been discharged cured, and 
another was recovering. 

At Great Foster House, near Egham, a gentleman had 
been brought to the house in a state of violent excitement. 
For seven successive nights he had no bodily restraint, 
but had two attendants in his bed room, and neither he 
nor they had had any sleep. He was continually get- 
ting out of bed and struggling with the attendants. The 
attempt to do without bodily restraint had been carried 



149 

to this extent, in some degree, in deference to the popular 
opinion, but it was then thought right not to continue 
it any longer ; and on the eighth night muflFs were put on 
the patient, and he soon after fell asleep, and slept 
throughout the night. On the next night, he recom- 
menced his violence, but the muffs being produced, he 
became tranquil and went to sleep, without its being 
necessary to put them on. This gentleman was dis- 
charged much improved, but not cured. The super- 
intendent stated his opinion to be, that the struggling 
with the attendants irritated, but the application of the 
muffs tranquillized the patient. 

The proprietor of the Asylum at Fish Ponds, near 
Bristol, stated that he believed that a patient in his 
house recovered entirely owing to his having bodily 
restraint. He had been previously watched by attendants. 
and was very much excited by it; when put under such 
restraint he fell asleep and gradually became tranquil. — 
The same good effect was produced, at Mr. Taylor's 
Asylum, near Bristol, on a female Patient, who was 
exceedingly irritated at being watched, but became 
quiet when placed under some slight mechanical restraint. 
— At Moorcroft House, Hillingdon, a patient was con- 
tinually striking himself with great violence, and we 
were informed would have produced serious, if not fatal 
injuries, unless he had been restrained. — In the Bethnal 
Green Asylum, a male patient, with dangerous propen- 
sities, was allowed to go unrestrained, and during this 
period assaulted a keeper, and kicked him so violently 
in the abdomen, that an abscess ensued, and the keeper 
was for some time in danger of losing his life. — At 
Northumberland House Asylum, a powerful maniac, one 
of whose hands it is now considered advisable to restrain 
by a strap, was permitted to go at large, during which 
period he struck the pointed end of a pair of snuffers into 
a keeper's head, and endangered his life. — We have, at 
different times, received numerous assurances that the 



150 



Remarks on the 
practice of re- 
straint. 



Additional ex- 
pense for Pau- 
pers in Private 
Asylums, if 
restraint dis- 
pensed with. 



Safety of attend- 
ants endangered 
by absence of 
restraint. 



use of mild mechanical restraint has had the eflfect of 
making the Patients tranquil and comfortable. 

It is possible, that cases such as those which we 
have instanced, may be managed without mechanical 
restraint. The question, however, in which the humane 
and intelligent medical practitioner is interested, is 
not whether it be possible, but whether it be prefer- 
able, in all cases, to dispense with such restraint alto- 
gether, and to substitute, in its stead, manual coercion 
and solitary confinement. It is necessary to observe, 
that a system of management which may be eligible 
under some circumstances, may not be equally so under 
others. That which may be practicable in large Asylums, 
may not be feasible in smaller Establishments. These 
and other circumstances must be taken into consideration, 
in estimating the practicability of adopting or rejecting 
a system, entirely interdicting the use of mechanical 
restraint. In Private Asylums which receive paupers, 
if it be desired that the Visitors shall requu-e an entire 
absence of mechanical restraint, the public must be pre- 
pared to pay an additional sum for their care and main- 
tenance of the patients, otherwise they must either suffer 
long-continued solitary seclusion, which will destroy 
their health, or the attendants and other patients will 
be exposed to constant peril. 

Attention to the safety and comfort of Attendants is 
a very important part of the duty of the proprietors of 
Asylums for the insane. It is a great object to 
secure the services of respectable and superior persons 
as attendants and nurses ; but if such persons are to 
be induced to take charge of the insane, it is necessary 
to assure them that they are not to lead a life of cease- 
less anxiety and to be in continual apprehension of vio- 
lence. 

On visiting the Asylum of Mr. Phillips, at De- 
vizes, we found that there were 153 patients in the 
House, and that one woman only was restrained, who 



151 

had just been quarrelling with some other patients, In 
the yard where she was, and which contained the worst 
class of females, there were more than twenty most 
violent and dangerous women, who, but for the presence 
of two experienced and very clever nurses, would pro- 
bably have injured each other. Whilst we were taking 
down the names of the patients, in one of the men's 
yards, aq athletic male Patient suddenly came up and 
struck the resident medical attendant a blow on the 
head, with all his force. Another keeper was sent 
for, and, with our sanction, a strap was put round 
the man's body, and one of his hands was fastened 
to it. 

Within the last few weeks, at Dr. Philp's House, at 
Kensington, the male patients had all been taken out to 
walk in the garden. A very powerful and dangerous 
male patient asked permission of the attendant to go into 
the house, to the closet. In a minute or two, shrieks 
were heard, and upon the servants rushing into the 
house, they found that he had seen the matron at a 
window, (who, in the absence of the patients, had gone 
to look over the men's rooms,) had attacked her in the 
most savage manner, and had knocked out seven of her 
teeth, and otherwise severely injured her. Her life 
was for some time afterwards in imminent danger. 

To these must be added the cases, already men- 
tioned, of the superintendent at Hilsea, and of the 
attendants at Whitmore House and Bethnal Green. 

The mild system now adopted in all the county Asy- Additional 
lums which do not profess to do entirely without attendants and 
restraint, has required the employment of an increased nurses required 

by adoption of 

number of attendants and nurses. In some of these xaili system. 
Establishments, it is considered that, although the com- 
fort of the patients has been promoted, the attendants 
have been subjected to greater risks, by the diminution 
of restraint. In order, however, to carry into effect, 
with perfect safety to the patients and attendants, a 



152 

system of entire abstinence from bodily or mechanical 
restraint, there ought to be a greater number of yards than 
some Asylums, such as those of Lincoln, Suflfolk, and 
Hanwell, possess, in proportion to the numbers of their 
patients. In Hanwell, for instance, the yards, which 
are of triangular shape, are comparatively small, mea- 
suring about 195 feet at the sides, and 120 at the base. 
One of these yards is open to two wards containing 90, 
another to four wards containing 197, and a third to 
five wards containing 124 patients. If, instead of only 
30, there were a large number of curable and recent 
cases in this Asylum, we think that, with the present 
accommodations, even more attendants than are now 
employed would be absolutely necessary. Any addi- 
tional yards must be attended with some increase of 
expense ; but if the entire disuse of mechanical restraint, 
and the substitution of solitary confinement, be more 
humane towards the insane, and more conducive to their 
cure, than the use of such restraint, the increase of 
expense will assuredly not be considered a sufficient 
justification for its continuance. Magistrates, however, 
before they decide upon adopting a system of managing 
their pauper lunatics, which will necessarily impose 
a considerable additional expense upon parishes and 
counties, will, of course, previously satisfy themselves 
that the advantages to be derived from it are real 
and sufficient to justify the additional cost. 
Opinions of During our visits to the dififerent Asylums, we have 

int^en'dents of"* endeavoured to ascertain the opinions of their Medical 
Asylums on Superintendents in reference to the subject of restraint ; 
and we will now state, in general terms, the result of 
our inquiries. Of the Superintendents of Asylums 
not employing mechanical restraint, those of the Hos- 
pitals of Lincoln, Northampton, and Haslar, and of 
the County Asylum at Hanwell, appear to consider 
that it is not necessary or advisable to resort to 
it in any case whatever, except for surgical pur- 



153 

poses. On the other hand, the Superintendent at Lan- 
caster hesitates in giving an opinion decidedly in 
favour of the non- restraint system : he thinks that 
although much may be done without mechanical re- 
straint of any kind, there are occasionally cases in which 
it may not only be necessary, but beneficial. The Su- 
perintendent of the Sufiblk Asylum considers that in 
certain cases, and more especially in a crowded and im- 
perfectly constructed Asylum, like the one under his 
charge, mechanical restraint, judiciously applied, might 
be preferable to any other species of coercion, as being 
both less irritating and more efiectual. — The Superin- 
tendent of the Gloucester Asylum states that he has 
adopted the disuse of mechanical restraint, upon the 
conviction which his experience has given him during 
a trial of nearly three years. — Of the Superin- 
tendents of Asylums who employ mechanical re- 
straint, those of the Retreat at York, of the Warne- 
ford Asylum, and of the Hospitals at Exeter, 
Manchester, Liverpool, and of St. Luke's, consider 
that although the cases are extremely rare in which 
mechanical restraint should be applied, it is, in some in- 
stances, necessary. Similar opinions are entertained by 
the Superintendents of the County Asylums of Bedford, 
Chester, Cornwall, Dorset, Kent, Norfolk, Nottingham, 
Leicester, Stafibrd, and the West Riding of York. — 
At the Retreat at York, mechanical or personal restraint 
has been always regarded as a " necessary evil," but it 
has not been thought right to dispense with the use of a 
mild and protecting personal restraint, believing that, 
independent of all consideration for the safety of the 
attendants, and of the Patients themselves, it may in 
many cases be regarded as the least irritating, and there- 
fore the kindest method of control. Eight of the 
Superintendents employing bodily restraint have stated 
their opinion to be that it is in some cases beneficial as 



154 

well as necessary, and valuable as a precaution, and a 

remedial agent; and three of them have stated that 

they consider it less irritating than holding with the 

hands, and one of them prefers it to seclusion. 

Practice in In all the Houses receiving only private Patients, 

Houses receiv- .... • i i j i • n t 

ing only Private ^Gstramt IS considered to be occasionally necessary. In 
Patients. ^j^g large and very well conducted Houses, where the 

Proprietors are persons of great experience, and where 
they have every means of separating and managing their 
Patients, and have large numbers of attendants and 
nurses, the application of restraint is considered at times 
not only necessary, but beneficial to the Patient. In 
several instances, Patients have been named to us who, 
apprehensive of their attacks coming on, have 
requested to be restrained for their own security. At 
the Cornwall Asylum, we found a man who volun- 
tarily wrapped his arm round Avith bands of cloth from 
the fear of striking others. He untied the cloth himself 
at our request. We know the case of one lady, who goes 
home when she is convalescent, but voluntarily returns 
to the Asylum, when she perceives that her periodical 
attacks of Insanity are about to return, in order that 
she may be placed under some restraint. 

We have thus endeavoured to state with accuracy the 
difference between the methods of treatment adopted 
by those who wholly disuse, and those who occa- 
sionally employ mechanical restraint ; the condition in 
which we have found the Public Hospitals, County 
Asylums, and Licensed Houses which are conducted 
according to these systems; and lastly, the opinions 
which have been expressed to us by the Medical 
Superintendents of these Institutions, as to the employ- 
ment or disuse of mechanical restraint. We have 
explained to your Lordship that, in our visitations 
to Lunatic Asylums, we have witnessed, without 
remonstrance, such measures of mechanical restraint 



155 

as, in the opinion of the Superintendents, sufficed to 
prevent dangerous or disgusting propensities, when 
assured that it was deemed necessary in the one case 
and expedient in the other; and that we have, in 
more than one instance, recommended the application of 
some mechanical restraint in cases of extreme violence, 
when the Medical Superintendent has told us that he 
scrupled to use it, out of deference to what he con- 
sidered to be the public opinion upon the subject, 
although he thought it necessary. 

Of the Asylums entirely disusing restraint, in some 
of them, as we have stated, the patients have been found 
tranquil and comfortable, and in others they have been 
unusually excited and disturbed. Without, however, 
attaching undue importance to the condition of the 
Asylums at the time of our visits, or to accidents 
that may happen under any system of managing the 
Insane, it is nevertheless our duty to call your Lord- 
ship's attention to the fact, that since the Autumn of 
1842 a Patient and a Superintendent have been killed ; 
a Matron has been so seriously injured that her life 
was considered to be in imminent danger ; another 
Superintendent has been so bitten as to cause serious 
apprehensions that his arm must have been amputated ; 
and two keepers have been injured so as to endanger 
their lives. These fatal and serious injuries and acci- 
dents have been caused by dangerous patients, and 
some of them in Asylums where either the system of 
non-coercion is voluntarily practised, or is adopted in 
deference to public opinion. 

Haying stated, in general terms, the opinions pre- 
vailing in the principal Asylums, for and against the 
system of absolute non-coercion ; it may be desirable, 
with the view of enabling your Lordship to judge more 
accurately of the value of each, to add the reasons (as 
far as we have been able to collect them) which the 



156 



Arguments of 
Medical Officers 
and Super- 
intendents advo- 
cating absolute 
non-coercion. 



several advocates adduce, for adopting or continuing 
their respective modes of managing or controlling the 
Insane. 

The Medical Officers and Superintendents who ad- 
here to the system of absolute non-coercion, never 
using mechanical restraint, even in cases of extreme 
violence, argue — 

1st. That their practice is the most humane, and most 
beneficial to the Patient ; soothing instead of coercing 
him during irritation ; and encouraging him when tran- 
quil, to exert his faculties, in order to acquire complete 
self-control. 

2. That a recovery thus obtained, is likely to be more 
permanent than if obtained by other means ; and that 
in case of a tendency to relapse, the Patient will, of his 
own accordj be more likely to endeavour to resist any 
return of his malady. 

3. That mechanical restraint has a bad moral effect 
that it degrades the Patient in his own opinion ; that it 
prevents any exertion on his part ; and thus impedes his 
recovery. 

4. That experience has demonstrated the advantage 
of entirely abolishing restraint, inasmuch as the condi- 
tion of some Asylums, where it had been previously 
practised in a moderate and very restricted degree, has 
been greatly improved, with respect to the tranquillity 
and the appearance of cheerfulness among the Patients 
in general, after all mechanical coercion has been dis- 
continued. 

5. That mechanical restraint, if used at all, is liable to 
great abuse from Keepers and Nurses, who will often 
resort to it for the sake of avoiding trouble to them- 
selves ; and who, even when well-disposed towards the 
Patient, are not competent to judge of the extent to 
which it ought to be applied. 

6. That the Patient may be controlled as effectually 



157 

without mechanical restraint, as with it ; and that the 
only requisites for enabling the Superintendents of 
Asylums to dispense with the use of mechanical restraint, 
are a greater number of Attendants, and a better system 
of classification amongst the Patients; and that the 
additional expense thereby incurred ought not to form 
a consideration where the comfort of the Patients is 
concerned. 

On the other hand, the Medical and other Superin- Arguments of 

jMcdicSil Officers 
tendents of Lunatic Asylums, who adopt a system of ^nd Super- 
non-restraint as a general rule, but make exceptions in mtendents who 

° ' ^ admit restraint 

certain extreme cases, — urge the following reasons for in extreme 
occasionally using some slight coercion. They affirm — 

1st. That it is necessary to possess, and to acquire as 
soon as possible, a certain degree of authority or influence 
over the Patient ; in order to enforce obedience to 
such salutar}' regulations as may be laid down for his 
benefit. 

2. That, although this authority or influence is obtained 
in a majority of cases by kindness and persuasion, there 
are frequent instances where these means entirely fail. 
That it then becomes necessary to have recourse to other 
measures, and, at all events, to show the Patient that, in 
default of his compliance, it is in the power of the Super- 
intendent to employ coercion. 

3. That a judicious employment of authority mixed 
with kindness (and sometimes with indulgence) has been 
found to succeed better than any other method. 

4. That the occasional use of slight mechanical re- 
straint has, in many instances, been found to promote 
tranquillity by day, and rest by night. 

5. That,, it prevents, more surely than any supervision 
can efi'ect, the Patient from injuring himself or the other 
Patients. 

6. That, particularly in large Establishments, the 
supervision must be trusted mainly to the attendants, 
who are not always to be depended on, and whose pa- 



158 

tience, in cases of protracted violence, is frequently 
worn out. That in such cases mild restraint ensures 
more completely the safety of the attendants, and con- 
tributes much to the tranquillity and comfort of the 
surrounding patients. 

7. That in many cases mild mechanical restraint tends 
less to irritate, and generally less to exhaust the Patient, 
than the act of detaining him by manual strength, or 
forcing him into a place of seclusion, and leaving him 
at liberty to throw himself violently about for hours 
together. 

8. That the expense of a number of attendants, — not 
indeed more than sufficient to restrain a Patient during 
a violent paroxysm, but nevertheless far beyond the 
ordinary exigencies of the Establishment, — is impracti- 
cable in Asylums where only a small number of Pau- 
pers are received. 

9. That the occasional use of slight coercion, parti- 
cularly in protracted cases, possesses this additional 
advantage ; that it gives the Patient the opportunity of 
taking exercise in the open air, at times when, but for 
the use of it, he would necessarily be in a state of 
seclusion. 

10. That the system of non-restraint cannot be safely 
carried into execution without considerable additional 
expense ; a matter which will necessarily enter into the 
consideration of those who are desirous of forming a 
correct opinion as to the precise benefits likely to arise 
from the adoption or rejection of such a system. 

11. That the benefit to the Patient himself, if indeed 
it exist at all, is not the only question ; but that it 
ought to be considered, whether the doubtful advantage 
to himself ought to be purchased by the danger to 
which both he and his attendants and other Patients 
are exposed, when restraint is altogether abolished. 

And 12thly. That, when a Patient is forced into and 
secluded in a small room or cell, it is essentially coer- 



159 

cion, in another form and under another name ; and 
that it is attended with quite as bad a moral effect, as 
any that can arise from mechanical restraint. 



VI. 

RELIGIOUS SERVICES. 



In respect to Devotional Exercises, and Religious Proper atten- 
Instruction, we have the satisfaction of reporting- to p^i^j fo religious 
your Lordship, that proper attention appears to be very observances. 
generally paid by the Proprietors and Superintendents 
of Asylums to these important duties ; that the service 
of the Church is, for the most part, regularly performed 
every Sunday ; and that Prayers are, in many cases, read 
on other days of the week, where there are Patients in a 
condition to benefit by them. We may state also, as 
the result of our inquiries, that the effect is tranquillizing, 
and productive of good order and decorum, in a remark- 
able degree, and in some instances permanently bene- 
ficial. 

The Patients are said frequently to look forward to the Eflfect on 
service with pleasure, and to consider exclusion from it '^'■i^"*^- 
as a privation. — Considering Religious Exercises in 
Lunatic Asylums merely as medical aids, and conducive 
to good order, they are of most important use. So long, 
at least, as the Service lasts, they occupy the Patient's 
mind, and set before him an example of quiet and deco- 
rum. The Prayers of the Church are eminently calcu- 
lated to produce a soothing influence upon even the 
insane hearer. Instances of misconduct or disturbance 
are said to be very rare ; and when they do occur they 
seem to produce much less effect upon the other 
Patients present than they would do upon persons not 



160 



Difference of 
opinion among 
Medical Offi- 
cers, &c. 



Appointment of 
Chaplains de- 
sirable. 



Practice adopted 
at various Asy- 
lums, 



accustomed, as the inmates of a Lunatic Asylum are, 
to scenes of noise and confusion, and to the occurrence 
of epileptic fits, or maniacal paroxysms, from day to day. 

In the opinion above expressed as to the tranquillising 
effect of Religious Exercises, — the Medical Officers and 
Superintendents of Asylums — with whom we have con- 
versed, are, almost without exception, agreed ; they 
differ, however, somewhat, in their views with respect 
to any permanent or lasting benefit being produced 
thereby upon the minds of the Patients. The experi- 
ence and observation of many Superintendents have 
led them to the conclusion that the temporary effect 
ceases with its cause ; and that after the conclusion of 
the Service, little or no trace is left of its soothing 
influence. They all concur in saying that Religious 
Instruction injudiciously imparted, and Controversial 
Discourses, are positively injurious. 

Without entering into the question whether or not 
Religious Exercises are of greater or more lasting benefit 
to the Patient than is commonly attributed to them, 
it is, we think, desirable, when practicable, to procure 
the assistance of the Incumbent of the Parish, or of a 
Clergyman in the neighbourhood, who should visit the 
Asylum regularly, in the capacity of a Chaplain, and who 
should be required to enter minutes of his visits in a book 
to be kept for that purpose; and that entry should be 
made of the number of Patients attending Prayers, from 
time to time. 

We have found, in some instances, that the Proprietor 
of the Asylum, or one of his Superintendents, or 
Keepers, or even one of the Patients, has been the only 
person in the habit of reading the Church Service, or 
other Prayers, to the Inmates. In one House (at Box) 
a Patient^ obviously Lunatic, was permitted to exhort 
his fellow- Patients every Sunday, in reference to their 
Religious Duties, in an extemporaneous address. In 
other places, a Keeper or Nurse (without any apparent 



161 

qualifications for rendering the subject as impressive as it 
ought to be) has been the only person delegated to read 
the service to the assembled Patients. 

The Proprietors of some Private Asylums have 
made arrangements, such as those to which we have 
adverted, with the Clergy in their respective neighbour- 
hoods. At Gateshead Fell Asylum, the Rector of 
the Parish attends once in a month, on Sunday 
eveningS) and performs Divine Service, which is 
read on the intermediate Sundays by the Proprietor. 
At Nunkeeling, the Incumbent of a neighbouring 
Parish has recently been licensed as Chaplain to 
the Asylum ; and at Gate Helmsley, a Clergyman 
from an adjoining Parish attends regularly every Wed- 
nesday, and reads the Evening Service, and "delivers a 
short discourse to the Male and Female Patients 
assembled Jogether. He also visits the sick. Similar 
arrangements have for some years been in operation 
in some of the larger Houses within the Metropolitan 
District. We adduce these cases, to which we might add 
others, as examples of those arrangements made volun- 
tarily by Proprietors of Asylums, which we think desir- 
able, wherever there are any considerable number of 
Patients capable of benefiting by the assistance of a 
Clergyman. 

We will now briefly notice the County and other 
Public Asylums; in the first of which we found, with one 
exception, Chaplains appointed, or the duties performed, 
(as at theDorset and Cornwall Asylums,) by the Chaplain 
to the County Gaol. At Chester there was no Chaplain, 
and the Service was read on Sundays by the Head 
Keeper and Matron respectively, on the Male and 
Female sides. We were informed that a Chaplain was 
about to be appointed ; and this was found, upon our 
second visit to that Asylum, to have been done. In 
some County Asylums, a large proportion of the Pa- 
tients attend the Service. This is the case at Chester, 
M 



162 

where the Service is now read, and a Sermon delivered 
every Sunday evening-. The effect is stated to be 
generally tranquillizing, and some of the Inmates appear 
to derive consolation from joining in it. At Leicester, 
the proportion of Patients who usually attend Chapel 
is about two-thirds of the whole ; at Bedford, Bodmin, 
and Stafford, one-half; at the Dorset Asylum, one-third ; 
and at Lancaster, one-fourth. The smallest proportion 
which we have found attending Chapel was at the 
Suffolk Asylum, viz., about 36 in 216, or one-sixth. 
The Medical Superintendent of this Asylum stated as 
his opinion, that the beneficial effect of the Service 
was doubtful, the number of those capable of under- 
standing it being very small. 

We had an opportunity of observing the quiet and 
orderly demeanour of the Patients during Service on a 
Sunday, at Lancaster ; and of witnessing the effect appa- 
rently produced upon about seventy of each sex, by the 
appropriate and impressive discourse of the Chaplain. 
At the Northampton Asylum also, we availed ourselves 
of an opportunity to attend the Morning Daily Prayers, 
which were read by a Chaplain, who visits the Asylum 
daily, and has keys of the wards. The conduct of the 
Patients was orderly and decorous. 

The Chaplain to the Bedford Asylum, with whom we 
had some conversation, expressed very decided views as 
to the comfort and benefit derived by Patients from 
Religious Services ; and mentioned the case of a female 
who, upon recovering her reason, described the pleasure 
she had experienced, whilst Insane, in attending Prayers. 

The average number attending Chapel at the 
Han well Asylum is 300, and the Holy Communion is 
administered to those who are considered in a fit state 
of mind to receive it. The practice adopted at Hanwell 
in regard to the selection of Communicants, is that, one 
fortnight before the quarterly administration of the Lord's 
Supper, the Keepers and Nurses are directed to give 



163 

iiotice to the Patients in their several wards, and to in- 
quire whether any of them desire to attend. Usually 
about fifty of each sex express a wish co do so. Their 
names are taken down, and from their number the Chap- 
lain selects those whom he thinks in a fit state to 
receive the Communion, These are on an average fifty 
in number ; namely, about thirty males, and twenty 
females. Their demeanour is said to be uniformly suit- 
able to the occasion. 

There is no Chaplain at the Lincoln Asylum. Prayers 
are read daily, and twice on Sundays, by the House- 
Surgeon, who considers the effect very beneficial, 
as tending, amongst other things, to revive devotional 
feelings. The result of our inquiries at St. Luke's 
Hospital was, that Prayers had never been read to the 
Inmates of that Institution ; but that a Chapel was in 
progress of being fitted up, and a Chaplain about to be 
appointed. At the Warneford Asylum, near Oxford, 
a Chapel has been recently built, for the use of the 
inmates. 



VII. 

ON THE ADMISSION AND LIBERATION OP 
PATIENTS. 



The law has required that no person, not being a Order and Cer- 
Pauper, shall be received into any Licensed House for f^^^es required 

'■ -' tor aduiission ot 

the reception of Insane Persons, without an order, Patients, not 
under the hand of the person by whose direction he is LkenTed 
sent, and without the Certificates of two medical men. houses. 

The order is to contain a full description of the Luna- 
tic, and the name, place of abode, and degree of rela- 
tionship, or connexion with the Lunatic, of the person 
signing the order. The medical men signing the Certi- 
M 2 



164 



Visitors to ex- 
amine Orders 
and Certificates. 



Orders and Cer- 
tificates not 
required by 
Public Hospi- 
tals : 



ficate are to examine the Patient separately, and are 
to comply with other particulars required by the Act 
of 2 & 3 Will. IV. c. 107. These Orders and Certificates, 
and the different particulars which they require, have 
been framed for the protection of the liberty of the sub- 
ject, and for the prevention of abuse in improperly con- 
fining those who are not insane. 

The persons who are appointed to visit Licensed 
Houses are required to examine these Orders and Cer- 
tificates. We consider this duty to be one of great 
importance, and are careful in our visitations to call 
attention to any irregularity which we discover in 
these documents. They enable us, in cases of difficulty, 
to communicate with the family of the Patient, and with 
the medical men who have signed the Certificates. 
Copies of the Orders and Certificates are sent to our 
Board, and enable us to give information of any person 
who has been placed in confinement. 

By 9 Geo. IV. c. 41, Public Hospitals were required 
to have Orders and Certificates of Insanity in the same 
form as Licensed Houses, but the clause requiring such 
Certificates was omitted in the Act of 2 & 3 Will. IV. 
c. 107. Private Asylums are not only required to have 
Orders and two Certificates previously to admission, 
but are subjected to visitation, whereas Public Hos- 
pitals may not only receive Private Patients without 
any Order or Certificate, but are not subject to any 
visitation. In 1815, the then Commissioners in Lunacy 
recommended to the Committee of the House of Com- 
mons on Madhouses, that the exemption of Public 
Hospitals for the Insane from the law for the regulation 
of Licensed Asylums, " should be confined to Pauper 
Lunatics admitted into such institutions as objects of 
charity, and not extended to those who pay, and some- 
times largely, for their accommodation." All the Lunatic 
Hospitals, by their own private regulations, require 
Certificates, before the admission of Patients, and gener- 



165 

ally in the same form as those which are required by law 
for Licensed Houses. This shows the opinion of the 
governing bodies of these institutions as to the propriety 
of requiring them. 

It is to be regretted that any difference has been Orders and 
made in the forms of admission of Private Patients into desirable in all 
any description of Asylum. No person ought to be •^^^^®' 
placed in confinement except under the strongest sanc- 
tion for its necessity, and under the written authority 
either of relatives or other persons, who may be applied 
to in case of doubt or difficulty. There is at least as much 
reason for requiring Orders and Certificates on the admis- 
sion of Insane persons into Public Hospitals, as into 
County Asylums. 

A gentleman who was a Private Patient in the County irregulariiies 
Asylum at Leicester, complained to us that he was con- '=°°^^^"^"'^ 

•^ ' r upon the S3'stem 

fined upon the Certificate of one medical man, who was of admission 

1 • XII -I • /. 1 -IT- • • i'l Public Hos- 

a relation, it has been the practice of the visiting pUals. 

Physician of the County and Subscription Asylum at 
Nottingham to sign Certificates for the admission of 
Private Patients into this Asylum. As regards Licensed 
Houses, such Certificates would be deemed irregular. 
In the Lunatic Asylum at Northampton, a Private 
Patient was pointed out to us by the Physician who was 
not insane, but had been sent there because her habits 
were a source of annoyance to her family. At the 
Public Hospitals, as well as at other Asylums, we meet 
with cases of persons who are termed morally insane, 
about the propriety of whose detention there are fre- 
quently great doubts. 

The provisions of the law respecting Certificates and Remarks on 
Orders for the admission of Insane persons into Asylums, P™^'sions of the 

^ ./J ia^v tor admis- 

require some notice. As regards Private Patients, Cer- sion into Asy- 
tificates of their insanity from two medical men are 
required for their admission into a Licensed House, anc? 
from only one medical man for their admission into a 
County Asylum. As respects a Pauper Lunatic, the 



166 



Practice at St. 
Luke's Hospi- 
tal; 



At the Glou- 
cester Asylum. 



Act 2 &3, Will. 
IV. c. 107, ss. 
46 & 47, dis- 
icgarcled. 



Certificate of his insanity must be signed by one medical 
man, and the Order for his admission into a County 
Asylum must be signed by two Justices, if for a 
pauper belonging to the county, and by one Justice if 
for a pauper of another county ; and by one Justice, or 
by the officiating Clergyman of the parish and one 
Overseer, if for his admission into a Licensed House. It 
appears to us to be desirable to have one form of Orders 
and Certificates for the admission of all Private Patients, 
and one form also for the admission of all Pauper 
Patients, into Asylums of every description. 

At St. Luke's Hospital, the Governors are in the 
habit of permitting Patients to go to their friends upon 
trial, and of re-admitting them as old Patients, without 
requiring any fresh Certificate, Hospitals are enabled 
to do this, because they are not required by law to 
have any Certificates for the admission of Patients. 
The subject has been frequently mentioned to us by the 
Proprietors of Private Asylums, and it may deserve 
consideration whether or not a power to permit the 
temporary removal of Patients, on trial visits, or for 
change of air, can be safely conceded to the keepers of 
Licensed Houses. If such temporary removals, or 
trial visits, are to be permitted, we think they should 
be allowed only under the express sanction and autho- 
rity in each case of Visiting Justices or Commissioners, 
after due inquiry. 

At the Gloucester Asylum, as has been stated to us, 
the Superintending Physician permits Patients, before 
they are discharged, to go home to their own families, 
and receives them again without requiring fresh Orders 
and Certificates ; and ten or twelve Pauper Lunatics 
appear to have ingress and egress from the Asylum at all 
times, at their own discretion. This practice is contrary 
to law, and appears to us to be open to serious objections. 

By the Act 2 & 3 Will. IV. c. 107, it is a misde- 
meanor to receive to board, or lodge, in any house not 



167 

licensed, any Insane Person, Pauper, or otherwise, 
without having the usual Order and Certificates 
required for Private Patients confined in Asylums, and 
copies of such Order and Certificates are directed to be 
transmitted to the Clerk of the Metropolitan Commis- 
sioners in Lunacy. The la\y in this respect appears to 
be wholly disregarded as respects Paupers, and very 
much evaded as respects Private Patients. No Orders 
or Certificates whatever, authorizing the reception 
of Paupers, are ever sent to our clerk, and those 
relating to Private Patients are so few in number as 
to render it manifest that the most culpable negli- 
gence exists. The 47th section of the above Act does 
not require the Orders and Certificates to be sent until 
within twelve months after a Patient has been received. 
The length of time allowed to send in the Orders and 
Certificates has, we incline to think, been one cause of 
the provisions of the Act being evaded. "We have 
reasons for believing that the Proprietors of Licensed 
Houses receive Private Patients in lodgings, without 
ever making any return of the Orders and Certificates, 
which they are required to receive and to transmit to 
our clerk. 

The object of the Law in requiring these Orders and Object of Orders 
Certificates is, that the place wherein every Lunatic is 
confined, may at all times be known, with the view of 
ascertaining his condition in reference not ouly to his 
state of mind, but also to the treatment which he re- 
ceives from the person with whom he is resident. 
From the information which we have obtained from Pauper Lunatics 
various quarters, there can be no doubt but that Pauper justmable re^-" 
Lunatics have been, and still are, subject to very severe straint. 
and unjustifiable restraint, in cases where they are singly 
confined, or boarded out in the houses of persons who 
receive them for small sums. In the County Asylum 
at Leicester there is a man now daily at work, and 
apparently cheerful and in good bodily health, who, for 



168 

seven years previously to his admission, was kept 
chained night and day in a small back room at Peckle- 
ton, in the same County. In the Asylum of Plymp- 
ton St. Mary, there is a Male Lunatic who was for- 
merly a Boarder for eleven years in a Private House, 
and during the whole of that time he was constantly 
chained. We found him without any restraint, and 
at work in the grounds of the Asylum. A poor 
woman was removed from the Asylum at North- 
ampton to board with another Patient ; but it was 
found absolutely necessary to send her back (twice) 
to the Asylum, because slie was kept upon so low a 
diet that relapses of her disease were brought on by 
want of more liberal food. "We have elsewhere stated 
our reasons for thinking that the condition of Pauper 
Lunatics, who are placed out as Boarders, deserves the 
attention of the Legislature. 
Liberation of The Liberation of a patient once properly certified to 

be Insane, manifestly requires the greatest caution. 
In almost every case, in which we have interfered to 
promote the liberation of a person confined as a Lunatic, 
we have considered it advisable, in the first instance, to 
recommend that the patient should be removed by his 
friends ; and it has been only on the refusal of the friends 
to act on our suggestion, that we have resorted to the 
power vested in us by the Acts of Parliament. In 
numerous cases, we have found, tliat the mind of the 
patient, even where he has derived benefit from having 
been confined in an Asylum, retains a feeling of ani- 
mosity towards the persons who originally authorised 
his confinement, and an impression that he has been 
injured by them. "We have, therefore, thought it right 
that these persons should have the opportunity, at a 
proper time, of doing an act which would, in all pro- 
bability, tend to remove or lessen this unjust feeling; 
and indeed it is not imimportant to the future well- 
doing of the patient liiraself, that he should recom- 



Patients. 



169 

mence his career in society with as few hostile prejudices 
and unfounded opinions, and in general with as little 
recurrence to his past state of mind, as possible. 

Instances are, besides, perpetually occurring in which Suggestions as 
a patient, although not completely recovered, is never- dual^liberation." 
theless in such a state of convalescence or improved 
health, as to render it desirable that he should have a 
certain amount of liberty allowed him, without possess- 
ing entire freedom. The transition from strict seclusion 
to complete liberty of action should, in many cases, be 
gradual. This is material, not only for the sake of 
tempering the patient, and inuring him, by a regular 
process, to unrestrained intercourse with society; but 
also as a test whereby his fitness for liberation may be 
ascertained, before he is made absolute master of his own 
actions. Endeavours, it is true, are made, in some of the 
better conducted Lunatic Asylums, to eficct this object, 
by classifying the patients, and regulating the degree of 
freedom allowed, by their advance towards recovery ; 
but there are cases where it may be preferable to remove 
the patient altogether from an Asylum, and from the 
presence of companions of disordered intellect, and to 
accustom him (under the supervision of a single attend- 
ant) to associate only with persons who are perfectly 
sane. This plan, by leaving in the hands of the patient's 
friends a certain power, which they themselves may 
gradually relax, invests them at once with the means of 
control, so long as it may seem necessary to exert it, 
and a considerable moral influence afterwards, when they 
have of their own accord restored the patient to the full 
enjoyment of his liberty. 

In reference to cases of this sort, where great improve- Commissioners 

, i_ , jy p . i.j.1 1 -ii Dot empowered 

ment, short oi pertect recovery, has taken place m the ^^ T partial 

health of a patient, it may be observed, that by the liberty. 

Acts 2 & 3 Will. IV. c. 107, and 5 & 6 Vict. c. 87, 

under which our authority is derived, we are empowered 

to liberate patients altogether; but that we have 



170 

no power to direct the continuance of any control or 
management after they have quitted an Asylum. The 
liberation of a person confined as a Lunatic, if it be 
effected by the exertion of our statutory powers, must 
be complete. 
Difficulty in Besides the cases last adverted to, there are others, not 

deciding on libe- „ . , . , 

ration in certain 01 partial or mcomplete recovery, but where the amount 
^^^^^- or character of the disorder is of such a nature as to 

present great difficulties in the exercise of our discre- 
tionary power of liberation. These are chiefly cases, 1st, 
of drunkenness ; 2d, of epilepsy and periodical excite- 
ment ; 3d, of weakness of intellect ; and 4th, of what 
has been termed moral insanity. 

Without laying down any precise rule on the sxibject, 
we have assumed, as a general principle for our guidance, 
that wherever a man of ordinary intellect is able so to 
conduct himself, that he is not likely to do injury, in 
person or property, to himself or others, he is unfit to 
continue as the inmate of a Lunatic Asylum. In judg- 
ing, however, of this likelihood to do injury, — in antici- 
pating, in short, the future good conduct of a person 
who has been once insane, from the present abated state 
of his malady, or from his apparent recovery, there is 
frequently extreme difficulty and always the most 
serious responsibility. In some cases, insanity may have 
been produced by temporary causes, which being re- 
moved, little probability exists of a return of the com- 
plaint. But the majority of cases proceed either from 
congenital causes, or from some organic defect in the 
system, inducing periodical returns of the disorder, in 
each of which cases there is little chance of complete 
cure ; or else from the depraved or imprudent conduct 
of the patient, against the repetition of which there can 
be. no security, that he will not relapse : there are cases 
also where the intellect possessed by the patient is so 
feeble or limited as to render it exceedingly perplexing 
to decide, whether he is or is not fit to be intrusted with 



171 

the management of his own affairs : and there are others, 
which modern writers class under the head of Moral In- 
sanity, many of which are scarcely distinguishable from 
cases of ordinary crime. It appears to us that these 
last, if admissible as instances of actual disease, should be 
admitted only after the most careful and severe scrutiny ; 
and that the shelter of a Lunatic Asylum should not be 
furnished, except upon incontrovertible grounds, to 
persons prima facie liable to be dealt with by the 
criminal law of the land. 

In all cases, whether of these or other species of Patients should 
insanity, it is clear that the patient, who apparently competenTper/ 

has claims to be liberated, should be examined and sons, previous to 

liberation, 
liberated only by persons familiar witli the disease, and 

as a consequence accustomed to observe the peculiar 

habits and moods of mind of the insane. 

So far as respects the exercise of the power of liber- Exercise of 

ation by the County Magistrates, we believe that a tyld^strates." 

patient has very rarely been discharged by them until 

he has been in a fit state to be restored to society ; 

there have been one or two instances, however, in 

which they appear not to have acted with their usual 

discretion. At the Witney Asylum, the Visiting 

Justices (with their medical attendant), examined a 

patient, who was confined there, and had been guilty of 

violence, twice in one day, and thereupon expressed 

their desire that the proprietor of the Asylum (a 

respectable medical man), would open his doors and let 

the patient out at once. He refused to do this without 

an order. The Justices urged this liberation, on the 

advice of their medical attendant, who had never seen 

the patient until that day ; and they soon afterwards 

brought the matter before our consideration, and two 

members of our body accordingly investigated the case; 

but they, after repeatedly examining the Lunatic, and 

hearing the evidence of various persons respecting his 

conduct and general habits, whilst out of the Asylum, 



17-2 

did not feel themselves justified in liberating him. It 
is right to add that this Lunatic, although somewhat 
abstracted and moody, did not present very obvious 
marks of disease. The testimony, however, corrobora- 
tive of his disordered state of mind, which was given 
by several persons, apparently unbiassed, was very 
strong. 

At the Licensed House at Nunkeeling, near Bever- 
ley in Yorkshire, the Visiting Justices liberated a dan- 
gerous Lunatic under unusual circumstances. We were 
informed by the brother-in-law of the Lunatic, and by 
the Proprietor of the House, that the Lunatic had been 
in a state of continued drunkenness for many weeks ; 
that he had threatened the life of his wife and child, 
under a delusion that he was not the father of the 
child ; and that two of the Lunatic's brothers had died 
insane. We found the following entry made by the 
Visiting Justices in the Visitors' Book, Dec. 19, 1842. 
" We have this day made a special visit to the Asy- 
" lum in order to examine into the case of P. H." 
(the Lunatic referred to), " who has been placed here 
" at the instance of his wife. He appears to be per- 
" fectly sane at the present, and unless sufficient cause 
" for his further detention be shewn to the Magistrates 
" assembled in Petty Sessions at Leven, on Thursday 
" next, the 22nd instant, we order that he be dis- 
" charged from the Asylum on Friday, the 23rd." 
This Lunatic had been confined under proper certifi- 
cates, and the Proprietor of the House remonstrated ; but 
the man was discharged, and afterwards threatened the 
life of his wife, who was obliged to leave her home, and he 
was then placed under the custody of the constables. 
The Justices, according to the act empowering them to 
liberate, ought to have visited this Lunatic three times 
(instead of once), and the real power of liberation 
belonged not to them, but only to the Justices assembled 
in Quarter Sessions: and we entered a statement to 



173 

that effect in the Visitor's Book, and pointed out the 
great risk of liberating a dangerous Lunatic under such 
circumstances. Cases of this sort, however, are, as we 
have said, extremely rare. 

But liberations or removals at the instance of the Frequency of 
patient's friends, or parish officers, are continually '"^^" ^^ 
taking place ; generally, indeed, only when the patients 
are reported convalescent, but frequently without the 
sanction of any visitors, and sometimes even against 
their remonstrances. With respect to patients who 
have ever been guilty of violence, it appears to us 
very questionable, whether their friends, or parish offi- 
cers ought, in any case, to have the power of authorising 
or procuring their discharge without the previous sanction 
of the Commissioners, or Visiting Justices, or other 
competent authority. At present, a violent Maniac, 
confined in a licensed Asylum, may, as it appears, be 
liberated and thrown back upon society, by the mere 
order of the relative, or other person, who originally 
placed him there. Now, whether this liberation be 
obtained by the importunities of the patient, or take 
place in order to save the expense attending his confine- 
ment in a Lunatic Asylum, or proceed from any other 
cause, short of the deliberate judgment of persons accus- 
tomed to observe cases of Insanity, it is, or may be, 
equally injurious to the public welfare. This power of 
liberating dangerous Lunatics, vested in or assumed by 
incompetent and irresponsible persons, is a subject that 
we think deserving of grave consideration. 

In reference to this part of the subject, we beg to Cases of irregu- 
state, that on our visiting the Refuge, at Hull, we found ^^"^ '^e"'"^'^*- 
an entry made by the Visiting Justices, disapproving of 
the removal of certain paupers by parish officers. From 
the inquiries we there made into the matter, we were 
induced to concur in opinion with the Justices, and 
we accordingly made an entry in the Visitors' book to 
that effect. Three cases were subsequently brought under 



174 

our notice by the clerk of the Visiting Justices of this 
Asylum. One was that of a quarrelsome Idiot, who had 
been confined for threatening to stab another person. 
The other two were Imbeciles ; one having been ad- 
mitted for obscenity of conduct, and the other being 
subject to fits of great excitement, and of considerable 
duration. Of these patients, one was removed by the 
Overseer, and the other two were discharged by two 
Justices of the county, who were not the Visitors. 
The letter accompanying the order for the removal 
of the Idiot, stated that she was not to be placed 
in the Union House, but with some quiet old woman. 
Two of these patients were dangerous, and all were 
removed uncured, in opposition to the opinion of 
the Visiting Justices, and of the proprietor of the 
Asylum. A fourth patient had been confined because 
she had taken a violent and unfounded dislike to her 
husband, and had threatened to poison him. She was 
removed on the day of our visit, by her husband, 
against the remonstrances of the proprietor of the 
Asylum, and notwithstanding that she had still the 
same dislike and expressed the same threat as formerly. 
We found in the same Asylum, a patient (a young 
man) who had been twice previously discharged; the 
second time contrary to the opinion of the superinten- 
dent, who did not consider him convalescent. Shortly 
after his second discharge, he met a relation whom he 
passed and afterwards followed and stabbed danger- 
ously in the side with a knife. He is now confined as 
a criminal Lunatic. The superintendent considered 
that this outrage would have been avoided, if he 
had had power to delay for a short time the patient's 
discharge. 

In the Asylum, at Newcastle-upon-Tyne, there was 
an extremely dangerous man, who had threatened the 
lives of his wife and children. When we saw him, he 
appeared perfectly rational, and we were informed that 



175 

he was staying in the Asylum in the hope of escaping 

the consequences of legal proceedings, commenced 

against him for some offence. The resident Physician ^ 

was of opinion that this man had sought shelter in the 

Asylum from the proceedings, and that (although a 

dangerous Lunatic) he would obtain his liberation as 

soon as all danger should have passed. 

It will be observed, that one of the cases which we Difficulty of 
have adverted to, as involving great perplexity, is that casesTf d'unk- 
of a patient whose insanity has arisen from drunkenness, ^nness. 
and who has apparently recovered. Such a person, at 
the commencement of his disease, is generally in a state 
of violent excitement, and likely to do injury to him- 
self or others. Cases of this description have fre- 
quently come under our consideration, within the 
Metropolitan district and elsewhere ; and the difficulty 
which we have experienced has been to determine for 
how long a period the patient ought to be detained in 
confinement after his malady has apparently ceased. 
We have thought it desirable that he should not be 
exposed too soon to the temptation of again indulging in 
strong liquors ; it having been almost invariably found 
that patients of this class, if liberated without having 
undergone a sufficient probation, are very liable to resort 
to their former practices, and to relapse. At the same 
time, we have considered that a Lunatic Asylum is not 
a place for the permanent detention of persons who 
have recovered the use of their reason, and are not 
obnoxious to the charge of unsoundness of mind, other- 
wise than on account of their liability afterwards to run 
into their former excesses, when restored to liberty. It 
has been our practice, in cases of this sort, to liberate 
the patient after a short confinement, if it be the first 
attack of Insanity from this cause, and if he appear to 
be aware of his misconduct, and to have a desire to 
reform his habits. In the event, however, of his being 
confined a second time owing to the same cause, we 



176 

have felt that his probation ought to continue for a 
much longer period ; and indeed we have felt that great 
responsibility has rested upon us in such a case, and 
have at all times very reluctantly, — and only after 
vainly endeavouring to induce the patient's friends to 
take charge of him, — resorted to our power of liberation. 
Instances of sane In reference to the subject of liberating patients, it is 
senuo Asylums, ^'^g^^ ^0 state that, in the course of our experience, we 
^^^^' have rarely found any patient confined in a Lunatic 

Asylum, who, as far as we could judge, had been sent 
there whilst in a decidedly sane state. Occasionally, 
the reasons for confining a patient at a great distance 
from his home, or for afibrding him an allowance 
apparently incompatible with his means, have required 
explanation, and this has not perhaps always proved 
satisfactory ; but there have been very few instances 
where the condition or conduct of the patient has not ■ 
been sufficient to justify or extenuate his confinement. 
Confinement At the same time, it must be added that confinement 
mu^crprolonged. ^^^ ^^ many cases been too far prolonged, and we have 
not unfrequently encountered a reluctance, on the part 
of the patient's relatives or parish officers, to remove 
him when he has been considered convalescent, and 
when in our opinion he might have been removed from 
the Asylum without danger. In the case of Private 
Patients, the reluctance of the relatives has often pro- 
ceeded from timidity, and occasionally perhaps from a 
wish to conceal the fact of the patient's insanity ; whilst 
the reluctance of parish officers has, without doubt, 
frequently arisen from a desire of saving expense, or 
from the circumstance of the patient having been found 
troublesome in the workhouse or union. In many of 
these cases, the parties have evidently been anxious to 
throw all the responsibility of the Act of Liberation 
upon the Metropolitan Commissioners. 

Power of libera- It is under circumstances of this nature, and also 
tion should be , ,, • • n • • .1 j !• ^i 

vested in some where the person originally signing the order for the 



177 

patient's confinement dies or goes abroad, (such person's persons under 

consent being required previously to the patient's dis- ^^"'^j'^'^ ^^ ^^° 

charge,) that we have felt our power of liberation to 

be of the highest importance and utility ; and we think 

that some such authority should always, under the 

sanction of the Legislature, be vested in some persons, 

in order to ensure due protection to the subject. 



VIII. 

STATISTICS OF INSANITY. 



■ The importance of Statistics of Insanity, and their General obser- 

intimate bearing upon the more immediate subjects of our ^**'°°^- 

inquiry, have induced us to resort to all accessible sources 

of information, for the purpose of estimating the actual 

numbers of the Insane, of all ranks, in England and 

Wales ; and of presenting, in one view, the numbers, 

with the several classes and conditions, of those confined 

in Asylums. Our inquiries have also comprised the 

prevailing forms and causes of Insanity, and causes of 

death, with the results of treatment, as far as they are 

deducible from the records of admissions and discharges. 

We have thought it expedient to confine ourselves, 

upon this occasion, to a few important heads, reserving 

others for future investigation. One reason for thus 

limiting our inquiries was, that, whilst it was desirable to 

collect the information from the various Asylums, public 

and private, in a uniform shape, many of those Persons 

by whom it was to be supplied were not in possession of 

suflScient data to enable them to furnish all the required 

details. 

The subject is one upon which, from the scanty and Erroneous no- 
uncertain nature of the materials for computation, the tj,g gybiec^ 



178 



Returns of Pau- 
per lunatics. 



Reports of 
County and 
Public Asylums. 



Commissioners, 
inquiries ex- 
tended to Scot- 
land and Ireland 



most erroneous notions have been formed by several 
writers who have treated upon the Statistics of Insanity 
By one writer, the number of the Insane in England was, 
in the year 1810, estimated at one in 7,300 of the popu- 
lation; by another, in 1820, the number was estimated at 
one in 2,000; by a third, in 1829, at 16,500, altogether, 
in England and Wales. It will be seen, in a subsequent 
part of this Report, how very far these estimates were 
from the truth. 

The means of arriving at a nearer approximation to 
the real numbers of the Insane in this Kingdom, have 
been furnished by certain returns of Lunatics and Idiots 
chargeable to Unions and Parishes, in the years 1836, 
1842, and 1843. Abstracts of these Returns have been 
prepared by the Poor Law Commissioners, and a copy of 
the last of these Abstracts will be found in Appendix F 
to this Report. The printed Reports of the various 
County and other Public Asylums, and the Statistical 
Tables drawn up by the Medical Officers of those In- 
stitutions, supply most valuable information. They are, 
however, plainly insufficient for general deductions. 
These circumstances, and the importance of the subject, 
led us to undertake the inquiry, the results of which we 
now present to your Lordship. Our acknowledgments 
are due to the Superintendents and Proprietors of Asy- 
lums, generally, for the readiness with which they sup- 
plied the information requested, and the labour bestowed 
by them upon their several Returns. 

We have (as will be observed) extended our inquiries, 
in a certain degree, to Scotland and Ireland ; in regard 
to which, we availed ourselves of the best private chan- 
nels to request information from the principal Institutions 
in Scotland ; the several District Asylums of Ireland ; 
Swift's Hospital, Dublin : and the large and important 
Pauper Asylum, at Cork. Our request was met most 
cheerfully by the Managers and Medical Officers of those 
Institutions, who have favoured us with Returns for the 



179 

most part full, and complete, which will be found at the 

end of the Separate Appendix. We have thought it due 

to the Parties furnishing the Returns, as well as desirable 

in other respects, to append to them extracts from the 

several communications by which they were accompanied, 

so far as the same appeared necessary for their elucidation. 

We come next to speak of the materials for the Registers, &c. 

statistics of Insanity, which exist in the shape of Returns ^^^^H be°kept 

required by Law, We shall, in the concluding portion in ^ prescribed 

form, 
of our Report, submit to your Lordship our views as to 

the propriety of prescribing certain forms of Registers and 
Medical books, to be kept in all Asylums, with a view to 
the preparation of Statistical Returns, at stated and uni- 
form periods. The absolute want in some cases, and the 
deficiency, and variety in form generally, of such Regis- 
ters, have tended much to enhance the difficulties we 
have had in procuring the necessary information, and to 
render it a work of much labour to the several Superin- 
tendents to supply it in the shape that we requested. 
The circumstance also of several of the Public Asylums 
making up their Annual Statements to a period of the year 
other than the 31st of December, has been a source of 
much additional trouble and inconvenience to some to 
whom we have been indebted for Returns applicable to 
the 1st of January, 1844. 

To revert to the subject of the Returns now required Ketums re- 
by Act of Parliament. The visitors of each County ^^^ ^ ^^' 
Asylum are bound by the Act 9 Geo. IV. c. 40, s. 56, to 
make annual Returns, * in the month of June, of the 
patients confined therein, or who shall have been confined 



* The Lists of Patients in County Asylums are directed to be 
sent to the Clerk of the Metropolitan Commissioners, appointed under 
the Act 9 Geo. IV. c. 41, who is to enter the same in a Register. 
The last-mentioned Act having been repealed, and the Metropolitan 
Commissioners being now appointed under the Acts 2 & 3 Will. IV. 
c. 107, and 5 & 6 Vict. c. 87, some County Asylums make no 
Returns to this Board. 

n2 



180 



not regularly 
made. 



Eeturn by Visit- 
ing Commis- 



by proprietors 
of Licensed 
Houses. 



therein within the twelve months preceding; and similar 
Returns are required by the Act 2 & 3 Will. IV. c. 107, 
s. 63, from Public Hospitals and Charitable Institutions.* 
These Returns, if universally made, would supply much 
useful information under the several heads to which they 
relate, more especially as to the Occupation and Profes- 
sion of the patients. It appears, however, by the collection 
of Returns, relating to County Asylums, printed by order 
of Parliament in 1842, that they are not universally made, 
and that some of those made apply only to the Patients 
admitted during the year. 

The Yisiting Commissioners are directed by the Act 
5 & 6 Vict. c. 87, s. 36, to require and transmit to this 
Board, a List, according to the form in Schedule B to 
that Act, of Admissions, Discharges, and Deaths, during 
the year ending the 31st December preceding. No one, 
however, is named in the Act to furnish the List.f 

As respects Licensed Houses, the Proprietors are 
required by the Acts 2 & 3 Will. IV. c. 107, ss. 30, 31, 
and 3 & 4 Will. IV. c. 64, ss. 3, 4, within two days after 
the Admission, Discharge, or Death of Patients, to trans- 
mit to the Clerks of the Peace, in the case of Pi-ovincial 
Asylums, and to this Board in all cases, copies of the 
Orders of Admission, and Medical Certificates, and 
Notices of Discharge, or Death, as the case may be, 
to be entered in a Register, by reference to which, the 
fact and also the place of confinement of any Inmate 
of a Licensed House may be ascertained. :{: Similar 
Notices are also required by the Act 5 & 6 Vict. e. 87, 
s. 27, to be given of escapes. It is very important 
that materials should be furnished for the formation of 
a correct and complete Register of Insane persons, 

* Xhe -A^ct does not specify the person -whose duty it shall be to 
make the Return, which is in fact made by one Public Hospital only. 

•j- The Superintendent of the Nottingham Asylum, on this ground, 
declined to furnish the List ■when required so to do. 

X The Commissioners have power to permit searches to be made for 
this purpose. 



181 

whefever confined ; and that regular Returns should be 
made, with this view, from all Asylums, Public and 
Private, in a uniform shape. 

The next class of Returns to which we shall advert, and Returns of Pau- 

, . , . . ... 1 per lunatics and 

which IS a most important one, as containing the only idiots. - 
authentic information upon the subject, furnished to Par- 
liament and the Public, applicable to the whole King- 
dom, is that of Lunatics and Idiots chargeable to Unions 
and Parishes. The Enactments upon this subject are 
the 9th Geo. IV. c. 40, and the new Poor Law Amend- 
ment Act, 5 & 6 Vict. c. 57. The first-mentioned Act 
is now confined to Parishes not comprised in Unions, 
the Overseers of which are still required, annually, in 
the month of August, to transmit to the Clerks of the 
Peace " lists of all Insane persons chargeable to their 
respective Parishes." These Returns, it is believed, are 
not very regularly made. 

The principal Returns of Pauper Lunatics are those 
made by the Clerks of Boards of Guardians, under 
the New Poor Law Amendment Act. These last 
Returns contain a variety of details, not supplied by 
the former ; and, if filled up with care, and by competent 
persons, would be more valuable, in a medical point of 
view, than they now are. It is plain, from these 
Returns, that a large number of Insane persons, 
returned under the head of Idiots, are not Idiots pro- 
perly so called, namely, Idiots from birth or infancy. 
The Returns, however, may be generally relied upon 
as regards the aggregate of Lunatics and Idiots charge- 
able to Unions. These, it is to be observed, probably, 
in many cases, do not comprise the Insane members of 
families chargeable as Out-door Paupers, of the numbers 
of which no means exist to form an estimate. There is 
also another class of Pauper Lunatics not included in 
the Returns; viz. — those maintained in Asylums at the 
charge of the several Counties. 

The only remaining Returns which we shall notice 



182 

are those required by the Act 2 & 3 Will. IV. c. 107, 
sect. 47, in the case of single private Patients, and de- 
" Private Re- nominated in the Act " Private Returns." They apply, 
2 & 3 W. IV. however, to those patients only who have been under 
*'' '^"'* the charge of the same individual for the space of one 

year. Of patients who have been under private care 
for shorter periods than a year, no Return is required ; 
so that a large class of Insane persons under certificate 
exists, in respect to whose number there are no materials 
for calculation. As regards also those of whom Re- 
turns ought to be made, it is believed that in a very 
small proportion of instances is the law complied with. 
This is abundantly manifest from the number, so far as 
it could be ascertained, in the month of January, 1844, 
and which was furnished to us with your Lordship's per- 
mission. This number was 37 only ; viz. — 24 Males, and 
13 Females. It is to be observed, also, that no notice is 
required to be given of removal or death ; so that whilst, 
on the one hand, a large number of certificated single 
Patients may, and no doubt does exist, of whom no 
Returns have been made, either from ignorance or neglect 
of the provisions of the Act on the part of the Persons 
having the charge of them, or because such Patients 
have not been under the care of any one Person con- 
tinuously for so long a period as a year ; on the other 
hand, those of whom Returns have been regularly made 
may have subsequently died, or been discharged, or 
removed by their friends. For these reasons, we have 
not taken the Class last mentioned into account, in our 
estimate of the present numbers of the Insane. Even 
if these Returns were complete, and all certificated single 
Patients were comprised in them, there would still 
remain a considerable class of Insane persons, of all 
ranks of life, under the care of Guardians or Rela- 
tives, without certificate, of whose probable number 
there are no means of forming an estimate. These 
considerations, as well as those suggested as to' 



183 

the numbers of the Insane Poor, are necessary to be 
borne in mind, in all calculations relative to the amount 
and prevalence of Insanity in this Country. 

With these remarks upon the existing' materials for Course pursued 
the Statistics of Insanity, we proceed to state to your sionerri^'their 
Lordship the course we pursued, and the nature and inquiry, 
objects of the Tables which we issued to the several 
Superintendents of Asylums. Copies of the Returns 
received, with a Tabular View of the state of the 
Patients in each Asylum on the 1st of January, 1844, 
will be found in a Separate Appendix. 

This Tabular View, to which we allude first in order, 
as forming (with information derived from other sources) 
the basis of a Census of Insanity, contains, as will be 
seen, a Statement of the Total Numbers of each sex, 
pauper and private, confined in Asylums on the 1st 
of January, 1844 ; their state as to probability of reco- 
very ; the number of Epileptics and Idiots ; of those 
with homicidal or suicidal propensities ; the condition 
of the Inmates as to marriage ; their several classes of 
life, and previous occupations ; the number of Criminal 
Lunatics (commonly so called); and of the Patients 
found Lunatic by Inquisition. It is only necessary to 
observe, in respect to the Returns from which the State- 
ment last mentioned has been compiled, that the greatest 
pains have been taken to insure accuracy, by repeated 
communications with- the various Superintendents of 
Asylums, and by obtaining from them, whenever 
necessary, explanations and corrections of their several 
Returns. 

The following Table exhibits the general results, in 
which the numbers found Lunatic by Inquisition have 
been corrected, by a statement furnished to this Board by 
the Board of Visitors of Chancery Lunatics. To this we 
subjoin a more detailed Abstract of the Returns made 
to this Board from the several Classes of Asylums. 



184 



General Statement of Insane Persons confined in Asylums 
England and Wales, I Jan. 1844. 







Males. 


Females. 


Total. 


Private Patients 

Paupers 

Total .... 


1989 
3532 


1801 
3950 


3790 

7482 


5521 


5751 


11,272 


State as 

to probability 

of 

recovery. 


^ ,1 fPnvate . . 
Curable „ 

J Pauper . . 

[.Total . 

T ,, fPrivate 
Incurable Ip^^p^^ . 

[^ Total . 


492 
687 


553 

787 


1045 
1474 


1179 


1340 


2519 


1497 
2834 


1248 
3157 


2745 
5991 


4331 


4405 


8736 


Epileptics 

Idiots . . .... 

Homicidal Patients .... 

Suicidal Patients .... 


575 
347 
180 
303 


376 
251 

98 
393 


951 

598 
278 
696 


Civil State. 


Married 
Single 

Widowed . 
Not known . 


1501 

3346 

340 

212 


1664 

2982 

798 

197 


3165 

6328 

1138 

409 


Class of 

life, and 

previous 

occupation. 


Upper and Middle Classes 
Agricultural . 
Artisan, and In-door 
Others .... 


1389 
1183 
1640 
1187 


1315 

469 

2228 

1629 


2704 
1652 
3868 
2816 


Criminal Lunatics .... 


202 


55 


257 


Found Lunatic by Inquisition . 


146 


87 


233 



185 









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The numbers as respects the Hanwell Asylum apply to the 30th of 
September, 1843, to which the Return from that Asylum was made 
up. The total numbers were on that day, 412 males and 563 femalesj 
total 975; whilst on the 1st Jan. 1844, the toUl number was 982 ; 
viz., 416 males and 566 females. 



Patients in 
Bethlem : 



186 

In the absence of any specific information upon the sub- 
ject, we have entered the Criminal Lunatics in Bethlem 
Hospital, viz. seventy Males and twenty Females, as 
Paupers. We have also assumed that the remainder of 
the Patients in Bethlem generally, are of the Private 
class, although we have reason to believe that some of 
them are maintained, wholly or in part, at the charge of 
Unions or Parishes. Seven male, and nine female, curable 
Patients, entered in the last printed Report, as " out 
on leave," have been added to the numbers returned 
as in the Hospital on the 1st of January, 1844. 

The Return from the Asylum for the County of 
Pembroke, at Haverfordwest,* as to the Patients confined 
therein on the 1st of January, contained merely a state- 
ment of absolute numbers, viz. eleven male, and six 
female Paupers. These Patients, consequently, are only 
found in the first Division of the Table. 

With respect to " Civil State," and " Class of life and 

and "Class of life previous occupation:" 232 Patients; viz. 122 Males, 
and previous . , ,. . , . 

occupation." and 110 Females (mcludmg those above mentioned m 

the Pembroke Asylum) do not appear under either of 

those Heads, the Returns received not having supplied the 

necessary information. The numbers omitted under the 

Heads to which we have last alluded are as follows, viz. ; 



at Haverford- 
west. 



' Civil state,'' 



Males. Females. Total. 



Haverford West Asylum . 


. 


. 11 


6 


17 


Bethlem Hospital 










Out on leave . 


. . 


7 


9 


16 


Incurables . 


. 


34 


50 


84 


Criminals 


. . 


70 


20 


90 


Guy's Hospital 






25 


25 




Total . 


122 


110 


232 



It is necessary to state this, in order to account for 



* No notice whatever was taken of any of the repeated applica- 
tions made for information ; nor was any answer received from this 
Asylum, until after the interference of the Chairman of Quarter Ses- 
sions, to whom a letter was addiessed upon the subject. 



187 



tients. 



the apparent inaccuracy of the general statement in the 
above respects. 

The condition of Pauper Patients in Asylums, as to Curable pa- 
probability of recovery, being made the subject of 
frequent observation in other parts of this Report, and 
being matter of great public interest, v?e have drawn 
up from the Returns the following Synopsis, which 
shews at one view the state, in this respect, of the 
Pauper Patients confined in the several Classes of Asy- 
lums, on the 1st of January, 1844 : — 

State of Pauper Patients in Asylums, as to Probability 
OP Recovery, 1 Jan. 1844.* 



Where Confined. 


Total Number of 
Pauper Patients. 


Curable. 


Proportion 

per cent. 

of curable 

to total 

Number. 


M. 

1951 
177 

360 
947 


F. 

2276 
166 

494 
973 


Tot. 

4227 
343 

854 
1920 


M. 

•297 
28 

46 
306 

677 


F. 

354 
31 

65 
331 

781 


Tot. 

651 
59 

111 

637 

1458 


County Asylums . . 
Other Public Asylums. 
Licensed Houses : — 

Metropolitan . . 

Provincial 


15f 
17 

13 

33A 


Total . . 


3435 


3909 


7344 


19^ 



The following Table exhibits the proportions per cent, 
of Curable to Total Numbers of Paupers, in the several 
County Asylums, on the 1st Jan., 1844, according to 
the Returns made to this Board : — 



Date of 
Opening 


County. 


Per 

Centage. 


Date of 
Opening 


County. 


Per 
Centage. 


1814 
1837 
1829 
1812 
1823 
1812 
1818 
1832 


Norfolk . 
Leicester . . 
Chester . . 
Notts. .. 
Gloucester 
Bedford . . 
Stafford . 
Dorset 


65| 
50^ 
30i 
29| 
21| 
191 
19i 
17f 


1829 
1818 
1816 
1833 
1820 
1831 
1841 


Suffolk , 
York W. Riding 
Lancaster . . 
Kent 

Cornwall . . 
Middlesex 
Surrey . . 





* Under the head County Asylums is included St. Peter's Hospital, 
Bristol, which is made, by a Local Act, subject to the provisions of 
9 Geo. IV. c. 40. The numbers in the Asylum for the County of 
Pembroke, at Haverfordwest, for the reasons before mentioned, are 
not included. St. Luke's Hospital is omitted, because of its particular 
constitution, recent cases only being admitted in the first instance ; and 
Epileptics, Paralytics, and Idiots, also aj;ed and infirm Patients, and 
those previously discharged uncured from other Asylums, being inad- 
missible; 



General obser- The remaining Tables require few observations^ 

Vations on ve- —ii i • i n .,,.,.. 

tnaining Tables, ^hey were prepared with all practicable simphcity, and 

in a form which was considered best calculated to obtain 

the desired information. The Returns apply, as will be 

observed, for the most part, to the period of five years, 

ending in 1843, and, with few exceptions, on the 31st of 

December. 

Some of the Returns of Admissions, Discharges, and 
Deaths, extend back to the dates of the opening of the 
Asylums, thus supplying the entire numbers of Patients 
who were in the Asylums at any time during the whole 
pei'iod. In other cases the numbers in the several 
Asylums, as they existed at the commencement of the 
periods included in the Returns, only have been given. 
For the purpose of Statistical deductions, the Returns 
last-mentioned are the same, in substance, as the former ; 
inasmuch as the Patients in each Asylum, at the time 
from which the statement of events commences, may be 
considered as having been then admitted, and the Asylum 
as having been then opened. 

With respect to the Per-centages of Cures and Deaths, 
contained in the Table to which we shall next advert, a 
diflPerence of opinion prevails as to the true principle 
upon which they should be calculated. Some persons 
are of opinion that they should be estimated upon the 
average numbers resident in the Asylum during a given 
period ; others upon the total number of discharges and 
deaths ; and a third class upon the total number who 
have been under care. We conceive that, for the purpose 
of instituting a comparison between the systems of treat- 
ment pursued in various Asylums, the first and second 
methods should be employed. It is hardly necessary to state 
that the greater the number of years over which the cal- 
culation extends, the more accurate will be the deductions 
drawn. It was our intention, in framing the Table, that the 
Per-centages of Cures and Deaths should be estimated 
upon the average numbers resident during each year. 



189 

The Returns appear to have been made, for the most 
part, upen this principle. In some, however, other 
methods have been adopted. 

The following- Table exhibits the per-centages of Cures 
and Deaths in the several County, and principal other 
Public Asylums, as deduced from the Returns made to 
this Board. Some trifling errors appear in those Returns, 
but not of a magnitude to affect the calculations in this 
Table. 



Per Ckntages of Cures and Deaths in County and principal other Public Asvlums. 















PROPORTIONS PER CENT. 




On average num- 


On total number of cases dis- 






ber resident in 


charged (including deaths). 






Asylum 


during 
years. 






1 


Asylum. 


Date of opening. 


lasts 


Since opening. 


During last 5 
years. 


Annual 


Annual 














Cures. 


Deaths. 


Cures. 


Deaths. 


Cures. 


Deaths. 


County Asylums. 
















Bedford 


Aug. 1812 . 


15-9 


10-5 


39-7 


23-3 


44-3 


29-3 


Chester . . 








Aug, 1829 . 


30-1 


11-8 


59-0 


30-0 


63-2 


24-7 


Cornwall* . . 








Aug. 1820 . 


13-4 


7-9 


— 


23-8 


47-6 


28-2 


Dorset 










Aug. 1, 1832 


15-6 


12-2 


58-5 


36-1 


52-9 


41-4 


Gloucester 










July 24, 1823 


31-7 


10-7 


65-5 


13-7 


61-7 


20-8 


Kent . . 










Jan. 1, 1833 


7-5 


10-7 


38-3 


47-3 


35-0 


50-0 


Lancaster . 










July 28, 1816 


16-6 


13-2 


48-2 


46-0 


52-4 


41-5 


Leicester . 










May 10, 1837 


36-1 


11-3 


18-1 


60-0 


60-7 


19-0 


Middlesex . 










May 16, 1831 


6-7 


9-1 


37-4 


55-7 


38-7 


52-9 


Norfolk , . 










May 18, 1814 


13-3 


19-1 


52-3 


45-4 


37-9 


54-4 


Nottingham 










Feb. 12, 1812 


24-6 


9-2 


15-8 


14-5 


58-4 


21-8 


Stafford . 










Oct. 1,1818 


21-0 


13-7 


— 


— 


42-7 


27-9 


Suffolk 










Jan. 1, 1829 


16-1 


10-8 


50-4 


33-7 


52-6 


35-3 


Surrey . . 










June 14, 1841 


— 


— 


47-8 


50-9 


— 


— 


York, West Riding 






Nov. 23. 1818 


17-1 


13-6 


50-1 


36-9 


48-0 


38-2 


St. Peter's Hospital, Bristol 


Incorp. 1696 


20-3 


19-7 


46-0 


27 3 


33-0 


32-0 


Other Public Asylums. 














Exeter 


July 1,1801 


47-6 


12-4 


54-1 


9-2 


47-6 


12-4 


Lincoln 


April 6, 1820 


17-9 


15-0 


42-2 


21-9 


33-1 


27-8 


Liverpool 


April 6, 1792 


62-7 


16-7 


41-2 


IM 


31-4 


8-3 


Northampton 


Aug. 1, 1838 


30.3 


14-0 


58-6 


28-3 


59-6 


27-5 


Warneford, near Oxford 


July, 1826 . 


22-4 


7-5 


54-7 


12-8 


600 


20-0 


York Asylum . . . . 


Sept. 20, 1777 


7-9 


6-8 


36-0 


21-7 


35-6 


30-6 


Friends' Retreat, York 


Midsm. 1796 


8-2 


5-7 


54-6 


26-7 


45-6 


31-7 



The Superintendents of some large Asylums have, 
in addition to the Returns requested, favoured us with 

* The Return from the Cornwall Asylum gives the Average num- 
bers and annual discharges and deaths, for the last three years only. 



fSO 



Total nurabers 
of Insane. 



some valuable statements which we have appended to 
their several Returns. As respects Bethlem Hospital, 
we have selected, from the printed Report of that Insti- 
tution, some of the most material Tables upon the 
several subjects embraced in the Returns from other 
Asylums. 

We proceed, in conclusion, to state, as far as cir- 
cumstances admit and materials for computation exist, 
the total numbers of Insane persons, Pauper and Private, 
in England and Wales, on the 1st of January, 1844. 
This statement, for the reasons we have given, can be 
considered only as the nearest practicable approximation 
to the truth. It may be depended upon, however, as 
exhibiting the minimum amount of Insanity, ascer- 
tained, or estimated upon authentic data. 

It was first necessary to compute the entire number of 
Pauper Lunatics and Idiots on the day to which the 
Census of Insanity applies. The means of doing so were 
furnished by the Abstract, to which reference has been 
made, of the Returns from the Clerks of Boards of 
Guardians, in August, 1843. 

The following Tables formed the basis of our calcula- 
tions : — 



Number of Lunatics and Idiots chargeable to Parishes included in 
Unions, in the years 1842 and 1843, according to Returns made 
under the New Poor Law Amendment Act, 5 & 6 Vic. c. 57. 



589 Unions, 
Aug., 1842. 


England 
Wales 


Population of the 
Unions, according 
to Census of 1841. 


Lunatics and Idiots. 


M. 


F. 


Total. 


12,978,377 
884,173 


5803 
507 


6909 
651 


12,712 
1,158 


591 Unions, 
Aug., 1843. 


England 
Wales 


13,152,341 
884,173 


6248 
523 


7367 
654 


13,615 
1,177 



Total number of In-door and Out-door Paupers relieved 

during the Quarter, ending Lady Day 1843 . . 1,539,490 

Lunatics and Idiots, as above .... 16,641 

Proportion per cent, to number relieved . . 1.08 



191- 

The two Unions which were formed, as appears by the 
above Table, between the years 1842 and 1843, were 
those of Oldham and Ashton-under-Line^ the former 
containing a Population of 72,394, and the latter 
101,570; together, 173,964. 

Upon the assumption that the aggregate number of 
Pauper Lunatics chargeable to Unions, bore the same 
proportion to that of Pauper Lunatics belonging to 
Parishes not in Union, which the aggregate Population of 
the Unions, according to the census of 1841, bore to 
that of the Parishes not comprised in Unions, the total 
numbers of Pauper Lunatics in England and Wales, in 
*he month of August of the years 1842, and 1843, 
respectively, were as follows : — 



1 

August, 
1842. 


England 
Wales 


Population 

of England and 

Wales. 


Lunatics and Idiots. 


Proportion 
per cent, to 
Population. 


ONE 

Lunatic or 
Idiotjto Per- 
sons Living. 


Males. 


Females. Total. 


15,253,890 
927,335 


6705 
523 


7983 
671 


14,688 
1194 


•096 
•129 


1039 

777 


Totals 


16,181,225 


7228 


8654 15,882 


•098 


1019 


August, 
1843. 


England 
Wales 


15,457,529 
939,7123 


715 
539 


8399 
674 


15,522 
1213 


•100 
•129 


1000 

777 


Totals 


16,397,244 


7562 


9073 


16,735 


•102 


980 



It appears from the last Table that the number of 
Pauper Lunatics, in proportion to the Population, had 
slightly increased from August, 1842, to August, 1843. 

We have taken the Population from the Enumeration 
Abstract, presented to Parliament in 1843. We mention 
this, in order to account for a trifling diflference which 
appears between the above estimate and that of the Poor 
Law Commissioners, who made use of the Population 
Returns as first received, which were rendered more 
perfect by some subsequent corrected Returns. A^^J/^ 

It is stated, by the Registrar General, in his report """^ 

^^^^ that <' the increase of Females," " in the ten years, 

1831 — 1841, was 14.17 per cent, or at the rate of 1.334 



192 



per cent annually ;" and he assumes, for the reasons he 
gives, that the Male Population increased at the same 
rate ; and that the increase, in both cases, was " uni- 
formly at that rate throughout the ten years." 

The computation which we have made in the lastTable, 
of the Population in August 1842 and 1843, respec- 
tively, and in that which follows, on the 1st January 
1844, has proceeded upon the hypothesis that the 
Population has increased at the annual rate above men- 
tioned, since the 6th of June, 1841, the date of the 
last Census. It has also, in the Estimate given of the 
actual number of Pauper Lunatics on the 1st of January, 
1844, been assumed that their numbers increased, from 
the date of the Poor Law Returns of 1843, in pro- 
portion to the Population. 

With this explanation, we present to your Lordship 
the following statement, to which we have added a 
Table, exhibiting the proportions per cent, on the 1st of 
January, 1844, of the numbers of Pauper Lunatics, 
Male and Female, in England and Wales, respectively, 
to the population of each sex: — • 

Total Number of Lunatics and Idiots Chargeable to 
Unions and Parishes on the 1st of January, 1844. 



England . . 
Wales . . . 


POPUI/ATION 

of England and 

Wales. 


Lunatics AND Idiots. 


Male. 


Female. 


Total. 


15,535,621 
944,461 


7159 
542 


8442 
678 


15,601 
1220 


Totals. 


16,480,082 


7701 


9120 


16,821 



193 



Proportions per Cent, of Pauper Lunatics to Population, 
January 1st, 1844. 



England . 


Males . . 
Females . 


Population. 


Pauper Lunatics. 


Proportion 
per cent. 


One Pauper 
Lunatic to Per- 
sons Living. 


7,589,659 
7,945,962 


7159 

8442 


•094 
•106 

•100 


1060 
942 


Total . . 


15,535,621 


15,601 


1000 


Wales . . 


Males . . 
Females . 


463,985 
480,476 


542 

678 


•117 
•141 


856 
709 


Total. . 


944,461 


1220 


•129 


775 


Total England & Wales 


16,480,082 


16,821 


•102 


980 


Deduct Criminal Lunatics 


279 






Total Pauper Lunatics not Criminals 


16,542 


•100 


1000 



It will be observed that the proportion of Pauper 
Lunatics to the Population is considerably larger in Wales 
than in England ; and that in both England and Wales 
the number of Females is greater than that of the 
Males, in proportion to the Population of the respective 
sexes. 

It only remains to add a general abstract of the results 
obtained from the various sources to which we have 
alludedj and which contains the nearest approximation, 
at which we have any certain means of arriving, to the 
total numbers of the Insane, Private and Pauper, in 
England and Wales, on the 1st of January, 1844. 



194 



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195 



IX. 



CRIMINAL LUNATICS. 



It has been matter of frequent complaint, that Asy- Objections to 

1 1 iirz-i'-iTj."- sending Crimi- 

lums are made receptacles tor Urimmal Lunatics, in- ^,^^ Lunatics to 
eluding all those who are confined under orders from the Asylums. 
Secretary of State, or Royal warrants. The objec- 
tions urged to their detention in Lunatic Asylums, 
and to the County Asylums being requbed to receive 
them, apply principally to those who have perpetrated 
atrocious crimes, and who are dangerous and a sourde 
of annoyance to the other inmates, whose liberty is, in 
some cases, abridged, in consequence of the necessity of 
providing for the safe custody of the Criminal Lunatics. 
In respect to these, the Asylum may be viewed rather 
in the light of a Prison than of an Hospital. 

Before proceeding further with our observations upon 
this subject, it may be convenient to refer shortly to 
the leading Enactments under which Insane Persons of 
this description are committed to Lunatic Asylums. 
These are, the Acts 39 & 40 Geo. 3rd, c. 94, and 3 & 4 Enactments 
Yic. c. 54. The first-mentioned Act applies to persons |^j^^[ Lunatics. 
" acquitted, on the ground of Insanity, of Treason, Mur- 
der, or Felony;" to Persons " indicted and found Insane 
at the time of Arraignment ;" to those "brought before 
any Criniinal Court to be discharged for want of prosecu- 
tion, appearing Insane ;" and to Persons " apprehended 
under circumstances denoting a derangement of mind, 
and a purpose to commit" an indictable crime. The 
Act also provides for the custody of Persons " ap* 
o 2 



196 



Number of Cri- 
minal Patients 
ia Asylums. 



Nature of 
crimes. 



pearing to be Insane, and endeavouring to gain ad- 
mittance to Her Majesty's presence, by intrusion on 
any of Her Majesty's Palaces or Places of Residence." 
The 3rd & 4th Vic, c. 54, extends the provisions of 
the 39th & 40th Geo. 3rd, c. 94, to cases of Misde- 
meanour ; and authorises the transmission to Lunatic 
Asylums of Persons becoming Insane, while in Prison. 
It applies to all persons " confined under sentence of 
Death, Transportation, or Imprisonment ;" " or under a 
charge of any offence, or for want of Sureties to keep 
the Peace, or to answer a criminal charge ; or in conse- 
quence of any Summary Conviction, or other than 
Civil process." The Act also empowers the Visiting 
Justices to make orders of maintenance upon Unions 
and Parishes, repealing certain provisions of the for- 
mer Act upon that subject. — It has been assumed, in 
practice, that the acts above cited are compulsory upon 
the visitors of County Asylums, and that they cannot 
refuse to receive persons committed under Royal war- 
rant. 

It will be seen by Schedule I, in Appendix G, (com- 
piled from the Parliamentary Return lately printed) 
that in April, 1843, there were 224 criminal patients 
confined in the several Asylums in this country, and 33 
in Gaols. Of the former number of criminals there 
were 85 in Bethlem Hospital, leaving 139 distributed 
in various County and Private Asylums. 

A considerable number of the Patients included in the 
above statement were cases of Larceny, and minor 
assaults, and other Misdemeanours, as to which com- 
paratively little objection existed to their being asso- 
ciated with other Patients in Lunatic Asylums. There 
were many cases, however, of an atrocious character, 
calculated to render the party dangerous, and an object 
of dread and disgust to those around him, such as 
Murder, Arson, and Unnatural Offences. Of these, as 
will be seen by reference to Appendix G, in Schedule II, 



197 

there were 50 instances in the Public and Private 
Asylums, exclusive of those in Bethlem. Amongst 
these, is the case of a furious and dangerous Maniac 
in the Chester Asylum, admitted in 1835, who had 
committed a murder, by strangling, under the most 
atrocious circumstances, and whom, in order to pre- 
vent him from killing or injuring those around him, 
it was found necessary to keep under constant restraint, 
both day and night. This man was, and had for some 
months been, the only patient under any kind of 
restraint in that Asylum. 

We believe that care is frequently taken to conceal, Criminality of 

T-r^. T n n 1 ' • 1 - Lunatics fre- 

from the other Patients, the fact of their associate being quently con- 
a Criminal Lunatic. This, however, cannot always be •'^aled from 

' "^ other Patients. 

effected ; and even were that possible, one objection only 
would be removed, to the practice of detaining criminals 
in Lunatic Asylums, possessing no proper Wards for that 
purpose. The risk of escape calls for arrangements Risk of escape. 
more stringent than those required in the case of other 
Lunatics. Some consideration, moreover, is due to the 
feelings of the relatives of patients, who have reasonable 
ground to complain of atrocious criminals being forced 
into their society. In reference to this part of the sub- 
ject, however, regard must be had to the nature of the 
offence committed by each Criminal ; since there are, 
without doubt, instances in which it would be hard to 
condemn a " Criminal Lunatic " to confinement in a sepa- 
rate Ward, or a distinct Institution. These cases, however, 
are exceptions, and leave the general objections untouched. 
In reference to the subject of Escape, we may mention 
the fact which came to our knowledge in the course of one 
of our Visits, that a criminal Lunatic had escaped from a 
Private Asylum at Plympton for the third time, and had 
not been re-taken ; and also that a male patient, committed 
by a Magistrate, as a dangerous Lunatic, to a Private 
Asylum at Nunkeeling, had escaped three times, had 
twice attempted the lives of his Keepers, and once to set 



198 



Practice at the 
Home Ofl5ce. 



Mr. Capper's 
evidence. 



fire to the Asylum ; and that the Proprietor of the Asylum 
had applied in vain to the Secretary of State, and to the 
Magistrates of the District, for the purpose of his being 
removed to a place of safe custody. At Gateshead 
Fell Asylum, also, there is a Maniac, who formerly 
escaped from the house, murdered his wife and daughter, 
and was (after his Trial) re-admitted as a Criminal 
Lunatic, and is now generally hand-cuffed, in order to 
prevent his again committing murder. 

The practice at the Home Office (as we learn from 
Mr. Capper's evidence before the Lords* Committee on 
Gaols, in 1835) is (upon being applied to in the case of 
any person acquitted on the ground of Insanity) to com- 
municate with the Visiting Justices, with a view to 
ascertain whether there is any Lunatic Asylum in the 
County, to which they propose his removal. Mr. Capper 
stated that considerable difficulties existed upon the 
subject, to which we need not advert. We may men- 
tion, however, the fact stated by him, that, as regarded 
the County of Middlesex, the Visiting Justices had 
remonstrated against Criminal Lunatics being sent from 
Newgate to Hanwell, although Middlesex prisoners, on 
the ground that the Hanwell Asylum afforded no 
security for that class of offenders. Mr. Capper, in his 
evidence, adverts also to a class of Criminal Lunatics 
of which we have found instances, both in County 
and Private Asylums, viz., those who after trial and 
acquittal on the ground of Insanity have proved not 
to be Insane, or who have become perfectly sane within 
a short period after their committal to a Lunatic Asy- 
lum, and yet are, "in many cases, too dangerous to 
" turn upon the public, having committed crimes of a 
" serious character." Mr. Capper suggests that, for 
such persons, a particular class should be formed in 
Prisons. 

We now beg to draw your Lordship's attention 
to some observations made by the Lord Chancellor 



199 

of Ireland, contained in a letter produced and read by Opinion of 
Mr. White (Inspector-General of Prisons) to the Lords' lor of Iicland.' 
Committee, upon the state of the Lunatic Poor of Ireland, 
in 1843. They are as follows: — "Solid objections 
exist to Criminal Lunatics being received into District 
Asylums, which never were intended for prisons. The 
advantages of bringing together all the Criminal Lunatics 
under the immediate eye of the Governor (^. e. of the 
Richmond Asylum, with which it was proposed to 
connect a detached Criminal Lunatic Establishment) is 
obvious. Their security could, easily be provided for, 
and strangers could be prohibited, from visiting that 
Department from motives of curiosity." 

We entertain a strong opinion that it is highly desir- Separate care 
able that arrangements should be made for the separate Criminar Luna- 
care and custody of Criminal Lunatics : and we would ^"^f '"glily 'Jesir- 

'' ^ _ able. 

submit to your Lordship that, as respects all Criminal 
Lunatics who have been charged with serious offences, 
and whom it is necessary to detain in custody, it is 
desirable that arrangements should be made with one 
or more Public Institutions, as Bethlem Hospital, or 
that a separate class should be formed in some con- 
venient Prison, so as to prevent their association either 
with other Prisoners, or the Inmates, generally, of 
Lunatic Asylums. 



X. 

WALES. 



We have now brought to a conclusion all the obser- Neglected state 
vations which we feel it necessary to make at present ^^^^ Insane at 
with regard to the care of Lunatics in England ; but it 
is our duty to bring under your Lordship's special con- 
sideration the very destitute and neglected state of the 
insane within the principality of Wales. 



200 

With the exception of the small Asylum at Haver- 
fordwest (so totally unfit for its purpose) before adverted 
to, there was no Asylum throughout the whole of the 
Principality until last year, when a House was licensed 
for Pauper and Private Patients, in Glamorganshire.* 

In 1843 there were in Wales 1177 Pauper Lunatics, 
according to the Poor Law Returns recently printed by 
the House of Commons. 

Of these 1177 Pauper Lunatics, it appears that 
thirty-six were in English County Asylums, forty-one in 
English Licensed Houses, ninety in Union Workhouses, 
and 1010 boarded with their friends and elsewhere. It 
has been represented to us that many of the Welsh Luna- 
tics, who have been in the English Asylums, have been 
very violent, and have been sent to them in a wretched 
and most neglected condition. When at Briton Ferry, 
we made the inquiries, directed by the Act, as to the 
condition of the Paupers on admission, and we were 
shown a letter, addressed by a Parish Officer to the 
Proprietor of a Licensed House, of which we give a 
copy. 

" Blaenbwch, I9lh December, 1843. 

" Sir, — We have got an Insane Female Pauper of the 
Union of Buillht, Breconshire ; she has been so for some 
years. Something has took her in her limbs about two 
years ago, until she is quite a cripple. I suppose it is 
owing to being kept in a close place, having no practice to 
walk. Please to write me the lowest you charge per 
week." 

In illustration of the statements we have received, as 
to the deplorable condition in which some of the Pauper 
Lunatics of North Wales have been found, and the 
necessity of providing an Asylum for them, we may 

* We are happy to be enabled to state that an Asylum, for Private 
and Pauper Patients, is about to be erected near Denbigh, The county 
of Flint has resolved upon uniting with Denbigh for this purpose. Two 
other counties of North Wales have decided against a union. 



201 

mention four cases described in a letter to the Editor of 
the North Wales Chronicle, dated 28th October, 1842, 
of which we have the permission of the Dean of St. 
Asaph to say, that he avowed himself the author. He 
states, " I have seen one secured in a dark and loath- 
" some shed, lying extended upon straw, (for the space 
" did not admit of his standing erect,) in a state of filth 
" that I dare not describe. A second was fettered and 
" manacled, and basking in the public street^ exposed 
" to the rude gaze of the thoughtless passers by. A 
" third I have seen led about the streets, and even to 
" Church, in the restraint of a strait waistcoat. A 
" fourth (I copy from a letter now before me of a Jus- 
" tice of one of the Welsh counties), died some time 
" ago in the most deplorable state, having been, for 
" about fifteen years, chained like a wild beast in an 
" out-house." 

We have recently received a letter containing import- 
ant particulars from the principal Medical Practitioner 
at Denbigh, a copy of which is set forth in the note.* 

Denbigh, June \4,th, 1844. 

* " A few months ago a poor woman, who was under great excite- 
•' ment from the mischievous teasings of a crowd of hoys and girls, 
" appealed to me in the streets of this town for protection. When I 
" got her into my house, and endeavoured, hy kind and conciliatory 
" language to soothe her, I found she had been chained by her hus- 
" band in a cottage, in a village four miles off, for many weeks. She 
" had been in an Asylum in England for some time ; but for want of 
' ' knowledge of her native language, no good could be effected. 

" I sent her to her friends under proper protection, and she was, I 
" lament to say, again consigned to the tender mercies of her husband, 
" who, to do him justice, had no other means of preventing the poor 
" creature from inflicting iujury upon herself and others. She is now 
" more calm, and goes about the country unprotected occasionally. 

" A few years ago, a poor girl not above a hundred yards from my 
" residence became deranged. From a dislike to send her from 
" home, amongst strangers unacquainted with her language and habits, 
" she was consigned to the care of a neighbour, who tied her down in 
" bed. — She made violent struggles to get away, and, in attempting to 
" escape from her keeper, fell down stairs and fractured her head. 

" I heard of a man a few months ago, whose family I am acquainted 
" with in Carnarvonshire, who was confined in a small room, unshaved 



202 

Other cases of a similar description were detailed at 
a recent meeting of the Committee of Magistrates of the 
County of Carnarvon. Among these, that of Griffith 
Jones excited painful attention. He had for some time 
been confined in a place in which there was no window, 
and the smell arising from it was nearly such as to suf- 
focate the Medical man who visited him. His bed was 
in a most filthy state, and his body covered with vermin; 
and he was altogether the image of starvation, despair, 
and wretchedness. He is since dead. 

In our visits to Wales, and upon other occasions, when 
inspecting houses in England, in which Welsh Pauper 
Patients were confined, we have made various inquiries 
as to the state of the Insane Poor belonging' to the 
Principality, and the information which we have 
received gives us every reason to believe that there is 
but little provision for the support, and still less for the 
cure, of these poor people, who are for the most part 
placed singly, either with their friends, (who are in the 
poorest station of life) or with strangers; a small pittance 
only being allowed in each case for their support. So 

" and uncleaned for nearly twenty years. He was once a Student of tlie 
" University of Oxford.* 

" There is now a man in Flint Jail, who was tried the last sessions 
" for cutting a poor woman dreadfully with a reaping hook, whilst in a 
" state of mania. He had been allowed to ramble about the country 
" for months in that state. 

" I am acquainted with two or three cases in this town at the 
" present time, who are unfit to be at liberty. I had myself a very 
" narrow escape some time ago of being killed by an infuriated Idiot, 
" who had been tormented by some boys, and who threw a paving- 
" stone at my head as I was passing by. 

" The state of the Welsh Lunatic, in general, is most pitiable and 
" miserable, — with no place of protection in his own country ; and the 
" only alternative is an English Asylum, where no real good can be 
" effected, and that at an enormous expense to his parish or his friends. 

" It is to be hoped that the Legislature will throw its protection over 
" him, as I fear his own Country will not without compulsion." 
(Siffned) " R. LLOYD WILLIAMS, Surgeon." 

* All the other persons alluded to, were Parish Paupers. 



203 

strongly are we impressed with the necessity of remedy- 
ing these evils, that we have directed some Members of 
our Board, who are about to visit the districts bordering 
on Wales, to make special inquiries, in reference to the 
general condition of the Insane throughout the Princi- 
pality, and we feel it our duty to bring distinctly under 
your Lordship's notice the fact that Wales, containing 
no less than 1177 Pauper Lunatics, has at present 
within its limits only one house Licensed to receive 36 
Insane Pauper Patients, in addition to the Asylum at 
Haverfordwest, upon which it has been our duty so 
strongly to animadvert. 



ASHLEY, (Chaieman). 

SEYMOUR. 

R. VERNON SMITH. 

J. HANCOCK HALL. 

R. W. S. LUTWIDGE. 

R. GORDON. 

THOMAS TURNER. 

FRANCIS BISSET HAWKINS. 

B. W. PROCTER. 

J. R. GO WEN. 

H. H. SOUTHEY. 

J. W. MYLNE. 

JOHN BARNEBY. 

W. H. SYKES. 

THOMAS WATERFIELD. 

J. C. PRICHARD. 

J. R. HUME. 



204 



SUGGESTIONS FOR THE AMENDMENT OF THE LAW. 



In the expectation that the Law, as it regards Lunacy, 
will shortly be subjected to revision. We trust that 
we shall not be thought to have exceeded the limit of 
our duties in offering the following suggestions to your 

Lordship. 

1. 
That there be provided for the Insane Poor of every 
County some proper and convenient Hospital or Hos- 
pitals for the reception of all recent cases. 
2. 
That the provisions of the Law, enabling Counties to 
unite for the formation of Asylums, be extended to parts 
of Counties, Towns, and places with separate jurisdic- 
tions ; and also to the union of Counties and Districts 
having no Asylums with others possessing such Institu- 
tions. 

3. 

That the 15th section of the Act 9 Geo. IV. c.40, 
be amended, by enabling a majority, being not less than 
two-thirds of the Justices of the Peace present at any 
General or Quarter Sessions, to direct or authorise 
tenants at rack-rent to detain out of their rent one-half 
of the full amount of all or any rates hereafter to be 
levied for building, enlarging, and repairing County 
Asylums, or in reference thereto. 
4. 

That in any County Asylum or Hospital hereafter 
to be erected, into which curable Lunatics (either alone^ 
or together with incurable Patients,) shall be received, 
the number of Patients shaU not exceed 230 in the 
whole. (See pp. 23, 24.) 
5. 

That some provision be made for the removal, from 
time to time, of Incurable Paupers from County Asy- 
lums, in order to make room for such as are curable. 



205 



6. 

That in the more populous Counties, such as Middle- 
sex and Lancashire, separate receptacles be established 
for Chronic cases ; to be conducted in a manner adapted 
to the wants of the Patients, but upon a less expensive 
scale than the present County Asylums. 
7. 

That if it be deemed a matter of necessity, under 
present circumstances, to confine some incurable Pauper 
Lunatics elsewhere than in receptacles expressly esta- 
blished for the purpose, they shall be kept, not in all 
Workhouses indiscriminately, but in some one specified 
Workhouse, or part of a Workhouse, within each dis- 
trict ; and that every such Workhouse, or part of a 
Workhouse, be properly adapted and exclusively appro- 
priated to the reception of Lunatics, and be regularly 
inspected by competent Visitors, and have regular Medi- 
cal Officers. 

8. 

That all Pauper Lunatics, confined elsewhere than in 
Asylums, be periodically visited ; and that periodical 
Reports be made upon their condition. 
9. 

That the Sites, Plans, and Estimates for every County 
Asylum hereafter to be erected, be referred to some 
Board or authority, constituted for the visitation and 
supervision of Lunatics, for the purpose of receiving 
suggestions, previously to the final adoption thereof by 
the Magistrates. 

10. 

That the Orders and Medical Certificates for the 
admission of Pauper Patients into any Asylum, or other 
place of confinement, be the same as are nov? required 
for their admission into Licensed Houses, and that no 
order be given unless the party signing has previously, 
seen the Patient.* 

IL 

That the Orders and Medical Certificates for the 

* At present, a Pauper is sent to an Asylum on one Certificate, and 
it does not appear necessary that the Magistrate, or other person signing 
the order for his confinement, should previously see the Patient. 



206 



admission of Private Patients into any Asylum, or other 
place of confinement, be the same as are now required 
for their admission into Licensed Houses. (See p. 163.) 

12. 

That no person certifying as to a Patient's Insanity, 
sign an order for his confinement.* 

13. 

That, with a view, amongst other things, to the for- 
mation of a complete Register of the Insane, notice of 
the admission, discharge, and death of every certified 
Patient, Private as well as Pauper, (excepting only those 
Patients of whom " Private Returns" ought to be made), 
be sent to the Metropolitan Board, within two days after 
every such admission, discharge, and death; and that 
in every notice of Admission, the day on which the 
Patient was received shall be stated, such day also to 
be endorsed upon the original order, and certificates, f 

14. 
That every County and Public Asylum or Hospital 
shall have a resident Medical Ofl&cer. 

15. ' 

That the Orders and Medical Certificates for the 
admission of Patients be a sufficient authority for 
re-taking them, in case of escape, at any time within 
eight days after such escape. 

16. 

That all Asylums and Hospitals for the Insane be 
subject to official visitation. (See page 33.) 

17. 

That the Official Visitors have power, at their discre- 

* In one or two cases, we have found that the brother or father of 
the Patient, being a medical man, has signed the order for confinement, 
and also certified as to the Lunacy. 

i" This will also facilitate the examination of the orders and certifi- 
cates upon the admission of private Patients into Asylums, and dispense 
with the necessity of referring to the Register of admissions in order to 
ascertain that the Patient was received within the period limited by law 



207 

tion, to give an order for the admission of any relation, 
trustee, or friend, to visit a certified Patient, wherever 
confined. (See page 75.) 

18. 

That the Official Visitors have power to fix and alter 
the Dietary of Pauper Patients in all Lunatic Asylums. 
(See page 49.) 

19. 

That the Lord Chancellor be empowered, upon the 
representation of the Board of Metropolitan Com- 
missioners, to suspend the Licence of any House 
licensed for the reception of the Insane. 
20. 

That it be lawful for the Proprietor or Superintendent 
of an Asylum, with the permission, in writing, of the 
Official Visitors, to take or send a Patient to any speci- 
fied place, for a limited time, for the benefit of his 
health. 

21. 

That, in the event of any Proprietor quitting a 
Licensed House for another licensed to him, it shall be 
lawful for him, with the previous permission, in writing, 
of the Official Visitors, to transfer his Patients from 
the one to the other, without fresh Orders and Medical 
Certificates,* 

22. 

That Licences be granted, in all cases, to the Pro- 
prietors of Licensed Houses, and not, as now, in some 
instances, to the Resident Superintendents. 
23. 

That no dangerous Lunatic be removed from any 
Licensed House against the advice of the Medical 
Attendant of the House, without the previous sanction 
of the Official Visitors. (See page 171.) 

24. 
That a full statement be published, annually, by 

* The want of such a provision occasioned considerable inconve- 
nience in a case which was brought under the notice of the Commis- 
sioners. 



208 

every County Asylum, of all receipts and disburse- 
ments; also of the property of the Asylum, the sources 
and amount of Income, and the application of the same. 

(See page 26). 

25. 
That in all Asylums, Public and Private, Registers 
and Medical Records be required to be kept, in a spe- 
cified and uniform shape ; and that annual statements 
of admissions and discharges, in a form to be pre- 
scribed, be made up to the 31st of December in each 
year, and transmitted to the Metropolitan Board. (See 
page 179.) 

The following, amongst other suggestions, have been 
received from the Clerk* to the Visitors of a County 
Asylum, who is also Clerk to the Board of Guardians, 
and are submitted for your Lordship's consideration. 

That the order of Commitment to the County Asy- 
lum should be made without requiring any adjudication 
of Settlement, so far as the Asylum is concerned. 

That the Union to which the Pauper is chargeable, 
should be liable to the weekly payments for Pauper 
LunaticSj until an order of payment shall have been 
made by Justices upon another District or Parish, upon 
application of the Board of Guardians. 

* EXTRACT FROM A LETTER RELATIVE TO THESE 
SUGGESTIONS. 
" The reason for these alterations arises from the difficulty too fre- 
quently experienced in obtaining the requisite evidence for the Justices 
to act upon, at the time the Patient is required to be sent to the Asy- 
lum ; and having recourse to the other provisions of the Statute is 
attended with many difficulties, as will appear from the cases decided 
by the Court of Queen's Bench, not one of which, I believe, has 
stood the test of a Judicial scrutiny, the Union from which a Patient 
is sent ought, in common fairness, to be chargeable with the expenses, 
until the place of legal settlement is found out— and I am of opinion 
that the practice should be assimilated to that under the Poor Law. 

A. Pauper is admitted into the Workhouse from the parish in which 

he last resided, and it is for that parish to get rid of the burthen by 
finding out the place of his legal settlement." 



APPENDIX A. 



COUNTY ASYLUMS, 

Erected under the Acts 48 George III. c. 96, and 9 George IV. c. 40. 



Beds. 



(Bedford) 
Chester 

(Chester) 

CORNWAI,!, . 



(Bodmin) . . 
Dorset . . 

(Foreton, near 

Dorchester) . . 
Gloucester . . 

(Gloucester) 
Kent .... 

(Barming Heath, 

near Maidstone) 
Lancaster . . . 

(Lancaster Moor) 
Leicester . . . 



(Leicester) 
Middlesex . 

(Hanwell) 



Norfolk . . . 
(Thorpe, near 
Norwich) . . 

Notts .... 
(Nottingham) . 

Stafford . . . 
(Stafford) . . 

Suffolk . . . 
(Melton, near 
Woodbridge) 

Surrey .... 
(Springfield, near 
Wandsworth) . 

York West Riding 
(Wakefield) . . 



Superintendent. 



J. Harris, Surgeon. 
J. Leete, Surgeon. 
D. F. Tyerman, M.D. 



G. P. Button, M.D. . 

S. Hitch, M.D. . . . 
G. S. Poynder, Surgeon, 



S. Gaskell, Surgeon . . 
H. F. Prosser, Surgeon. 



— Godwin, (Governor) 



Visiting- ? J. Conolly, 
Physician S M.D. 

House- P'm'I;,"^' 
Surgeons ^^p^^^^j^p 

Ehenezer Owen . . . 



T. Powell, Surgeon. 
Jas. Wilkesj Surgeon. 
J. Kirkman, M.D. 



S. Hill, Surgeon. . 



C. C. Corsellis, M.D. 



Date of 
opening. 



1812 



1829 
1820 



1832 

1823 
1833 

1816 
1837 



1831 



1814 



1812 
1818 
1829 



1841 



1818 



Weekly charge 
for Paupers. 



s. d. 
(0 7 6 
Out County. 
8 6 
(b)4 1 
Out County. 
10 
5 6 
Non- Contri- 
butory Dist 
10 6 
(a) 7 



(a) 9 
(a) 8 6 

(a) 6 

(b)8 6 

Out County. 

12 

(a) 7 7 

Out County. 

14 



(a) 5 3 

Out County. 
8 
(a) 8 

(a) 7 

(a) 5 10 
Out County. 
8 10 
(a) 9 



(a) 7 



Numbers, Jan. 1, 1844. 



Private. Pauper. Total. 



Totals 



9 

20 

68 
27 



52 
62 



245 



139 
155 
133 

107 



*975 



164 

125 
183 
206 

382 
433 



4155 



189 


257 


249 


249 


611 


611 


104 


131 



139 
164 
153 

107 



975 



164 

177 
245 
213 

382 
433 



4400 



(a) Including clothes. 



(b) Not including clothes. 
P 



* Sept, 30, 1843 



210 



ASYLUMS MADE, BY LOCAL ACTS, SUBJECT TO THE PROVISIONS 
OF 9 GEORGE IV. c. 40. 





Superintendent. 


Date of 
Opening. 


Weekly 

Charge for 

Paupers. 


Number 

1st Jan., 1844, 

(Paupers.) 


St. Peter's Hospital, Bristol. 

County of Pembroke, Haverfordwest. 
Workhouse, Kingston-upon-HulL* 


— Brady, Surg, -j 
G. Hampson. 


Incorporat- 
ed 1696. 1 


• • • 


72 
17 




Total . . .1 


89 



MILITARY AND NAVAL HOSPITALS. 



Hospital. 


Nature. 


Principal Medical Officer. 


Numbers 1st January, 1844. | 


Commissioned 
Officers. 


Non-Commissioned 
Officers and Pri- 
vates. 


Total. 


Fort Clarence, Chatham 
Haslar Hospital, Gosport 


Military 
Naval 


Andrew Smith, M.D. 
Sir W. Burnet, M. D., 


21 

29 


49 
69 


70 
98 




Total ... 


168 



BETHLEM AND ST. LUKE'S HOSPITALS. 








Where situate. 


Steward. 


Numbers, Jan. 1, 1844. 


Curable. 


Incurables. 


Criminals. 


Bethlem Hospital 

St. liuke's Hospital . • 


St. George's Fields . " 
Old Street, City Road 


Mr. Nicholls . 
Mr. Stinton . 


181 
93 


84 
84 


90 


-'■■- 1 

Totals . . 1 


274 1 168 


90 



OTHER PUBLIC ASYLUMS AND HOSPITALS. 
Supported wholly, or in part, by Charitable Contributions. 





Name of Asylum. 


Superintendent. 


Date of 
opening. 


Weekly 
charge for 
Paupers. 


Numbers, 
Jan. 1, 1844. 


Pri- 
vate 

47 
25 
30 

37 
36 

50 

t66 

42 

105 

98 

536 


Pau- 
per. 

1 

73 

36 

181 

52 
343 


Tot. 

48 

25 

103 

73 
36 
■23) 
66 
41' 

157 
98 

879 


Exeter . . 
Guy!s Hospl. 
Lincoln . . 

Liverpool 
Manchester , 
Northampton 
Norwich . 
Oxford . . 
(Headington) 

York . . 
Ditto . . 


St. Thomas's .... 
Lunatic Ward .... 
Lunatic Asylum . . . 

Lunatic Asylum . . . 
Lunatic Asylum . 
General Lunatic Asylum 
Bethel Hospital . . . 
Warneford Asylum . 

Asylum'. 

Friends' Retreat . . . 


Luke Ponsford, Surgeon. 

W. Graham . . . . 
House Surgeon. 

G.Tyrrell 

T. 0. Prichard, M.D. . 
— King. ..... 

F. T. Wintle, M.D. . . 

S. Alderson, Surgeon. 
J. Thurnam, M. D. . . 


1801 
.1820 

1792 

1838 
1713 
1826 

1777 
1796 


• s. d. 
' 15 

(b) 10 

12 
(b) 9 

f(a)M.7 6 
\Fem. 6 6 


Totals . . 



(a) Including clothes. (b) Not including clothes. 

* It has recently come to the knowledge of the Commissioners that this Workhouse is, by a Local 
Act, (5 Geo. IV. c. 1.3,) constituted an Asylum, subject to the County Asylum Acts. 

f It is believed that some of these are maintained p.artly at the charge of Parishes. 



211 



METRO!*OLITAN LICENSED HOUSES. 
RECEIVING PRIVATE PATIENTS ONLY. 



PEOPRIETOR. 



Ayres, William (Surgeon) 

Bell, Robert 

Birkett, Richard 

Bradbury, Mrs. Mary 

Burrow, Miss 

Bush, John (Surgeon) 

Cole, James 

*Co8tello, W. B., M.D 

Diamond, W. B. (Surgeon) . . . . 

Fleming, Mrs. Mary 

Haines, W. F. (Surgeon) 

*Homer and Co., Edward 

Jackson, John Thompson 

Kerr, Alfred George (Surgeon) . . . . 

Magnall, Mrs. Martha 

Monro, E. T., M.D 

Oxley, William (Surgeon) 

Parkin, John (Surgeon) 

Philp, F. R. M.D. and Finch, C. H.M. . 

Pierce, Miss Mary Ann 

Roy, D. T, (Surgeon) 

*Sloman, Harriet, Mrs 

Smith, William 

Steward, J. B., M.D., and Daniel, G.W. \ 
(Surgeon) . .•....,/ 
Stilwell, Arthur (Surgeon) and W. 

Sutherland, A. R., M.D 

Sutherland, A. R., M.D 

Symmons, Eliza, Mrs. and Co. . . , 

Talfourd, Ann, Mrs 

Tow, James 

Williams, Walter Davis, M.D. . . . 

Wood, Susan, Mrs 

Warburton, John, M.D 



HOUSE, AND WHERE SITUATE. 



Mare Street, Hackney . . . 
Manor House, Chiswick . . . 
Northumberland House, Stoke Newingti 
Earl's Court House, Old Brompton 
Grove House, Stoke Newington Green 
Retreat, Clapham ..... 
Dartmouth House, Lewisham , 
Wyke House, Sion Hill, Brentford 
Western House, St. Pancras 
Warwick House, Fulham Road 
Harefield Park, Uxbridge . . 
Lawp House, Hanwell . . . 
Turnham Green Terrace . . 
17, Pembroke Square, Kensington 

Hanwell > 

Brook House, Upper Clapton 
London Retreat, Hackney . 
Manor Cottage, King's Road, Chelsea 
Kensington House, Kensington 
Beaufort House, Fulham . . 
Hope House, Brook Green . 
Oak Tree Cottage, Harrow • 
Lampton House, Hounslow 

Southall Park 



Moor Croft House, Hillingdon 
Blacklands House, Chelsea . , 
Otto House, Fulham . . • . 
Cowper House, Old Brompton . 
Normand House, Fulham 
Althorpe House, Battersea . 
Pembroke House, Hackney 
Elm Grove House, Hanwell 
Whitmore House, Hoxton . . 



No. of 
Patients, 

Jan. 1, 

1844. 

Private. 



5 
16 
46 
26 
13 
12 
13 

13 
5 
2 

2 
2 
5 

34 
28 
15 
55 
5 



10 



30 
30 
22 
39 
18 
12 
95 
7 
41 



RECEIVING PAUPERS. 





Weekly Charge 
for Paupers.t 


Private. 


Pauper. 


Armstrong, Peter 

Lee, Henry Boyle (Surgeon) 
Warburton, John, M.D. . . 


Peckham House .... 
Hoxton House, Hoxton . . 
Bethnal Green .... 


s. d. 

10 

9 

9 8i 


48 

81 

226 


203 

315 
336 



* House Licensed since 1 Jan. 1844. 



f For maintenance, medicine, and clothing. 



212 



PROVINCIAL LICENSED HOUSES. 

RECEIVING PRIVATE PATIENTS ONLY- 



PROPRIETOR. 






Beds. . 
Bocks. 
Devon 
Dorset 

Esses . . 
Gloucester 



Hants 
Herts . 
Kent . 

Lancaste 



Leicester 

Lincoln . 
Norfolk , 



Northumberland 
Oxon . 



Somehset . 

Stafford . 
Suffolk . 
Surrey 

Sussex . 

Warwick . 



Wilts . . 
York, E. R. 



Do. W. R. 



Do. City & Subs. 



Harris, J. (Surgeon) . . . 
Horner and Harper, Messrs. 

Rich, James (Surgeon) . . . 

Mercer, J 

Sj'mes, W. (Surgeon) . . 

Allen, M. (M.D.) . . . . 

ConoUy, W. (M.D.) . . . 

Eyre, T. D 

Fox, H. H. (M.D.) , . . . 

Mules, C 

Taylor, M.( Mrs.) 

Burnet, C. M. (Surgeon) . . 
Smith, James (Surgeon) . . 

Harmer, J . 

Newington, J. N. (Surgeon). . 

Edwards, E 

Haigh, E. (Mrs.) 

Lomas, G 

Kershaw, P 

Owen, J 

Squires, Richard (Surgeon) 

Benfield, C 

Willis, F. (M.D.) . . . . 
Nichols and Watson (Messrs) . 
Pedgrift, Robert (Surgeon) . . 
Steele, H. (Surgeon) . . . . 
Wright, W.( M.D. )& Dalrym-I 

pie & Cross, Messrs. (Surg.) / 
Keenlyside, J. W. . . . 

Batt, E. A. (Surgeon) . . . 
Mallam, Richard (Surgeon) 
Fox, F. K. (M.D.) and C. \ 

J. (M.D) . . . . / 
Langworthy, R. A. (M.D.) 
Baliewell, G. S. (M.D) . . . 
Woody, Alice (Mrs.) . . . 
Chevallier, J. Rev. (M.D.) . 

King, Jane (Mrs.) 

Chapman, (SirJ. )&Co.(Surgs.) 
Stedman, Jas. (M.D.), & others 
King, W. (M.D.) . . 
Newington, C. (Surgeon) 
Do. do. . 

Brown, Henry (Surgeon) 
Boddington, G. (Surgeon) 
Burman, H. (M.D) . . 
Ogilvie, G. S. (Surgeon) 
AUanson, W. (Surgeon) 
Atkinson, J. (Surgeon) . 
Durham and Haigh, (Messrs 
Hodgson, H. B. (Surgeon) 
Kitching, J. (Surgeon) . 
Smith (Surgeon), Smith, P 

(M.D.) 

Allis, T 

Beleombe, H. S. (M.D.) 
Dawson, W. . . " . . 
Tose, E. (Mrs.) . . . 



:} 



Springfield House, Kempston, Bedford 
Denham P.trk, near Uxbridge . . 
Ford House, Church Stanton . . . 
Portland House, Halstock .... 

Cranboume 

High Beach, near Epping . , 
Castleton House, Charlton Kings. 

Cheltenham .... 
Upper Bath Road, Bristol . . 
Northwoods, Winterboume . . . 
Ridgeway House, near Bristol . . . 
Whitehall House, St. George's, Bristol 
Westbrook House, Alton .... 
Hadham Palace, Much Hadham . . 

Hawkhurst 

Goudhurst 

Blakeley House, near Manchester . 
Heath Green, Newton, do. . . . 

Clifton Hall, do 

Billington Whalley, near Tew . . 
Brook Villa, West Derby, Liverpool . 
Walton Lodge, near Liverpool . . 
Wigston House, Great Wigston . . 
Shillingthorpe House, near Stamford 
Heigham Hall, near Norwich . . . 

Loddon 

Stoke Ferry 



Heigham Retreat, near Norwich . . 

Belle Grove House, Newcastle-on-Tyne 

Witney . . . * 

Hook Norton 



Brislington House, near Bristol . . 

Longwood House, Ashton, do. . . 

Oulton House, Stone 

Moat House, Tamworth .... 
A spall Hall, near Debenham ... 
Wherstead Road, Ipswich .... 
Great Foster House, Egbam . . . 
Lea Pale House, Stoke, near Guildford 

Ringmer, near Lewes 

Asj'lum, Ticehurst "I 
Highlands, do. J 

Henley in Arden 

Driffold House, Sutton Coldfield . . 

Henley in Arden 

Calne 

Retreat, Rillington, near New Malton 
Weaverthorpe, near Sledmere . . 
Field Head House, Wakefield . . 
Acomb House, near York . . . . . 
Painthorpe House, near Wakefield . , 

Castleton Lodge, near Leeds . . . , 

Osbaldwick, near York 

Clifton House, York 

St. Maurice House, York . . . . 
Terrace House, Osbaldwick , . . . 



213 



PROVINCIAL LICENSED HOUSES. 
RECEIVING PAUPERS. 



PROPRIETOR. 



Derby 
Devon 



Durham 



Essex . . 
Gloucester . 

Hant ; . . 

Hereford 

Kent . . 
Lancaster 
Northumberland 
OxoN . . . 
Salop . . 

somkrset . . 



Stafford , 

Suffolk 

Warwick 

Wilts 



Wilts 



•! 



Worcester 
York, N. R 
Do. E.R. .| 

Do. W. R. 



Brjgstocke, (M.D.) . . . 

Lancaster, John 

Langwoithy, R. C. (Surgeon) 

Eales, J., and Sister . . 
Glenton, F. and P. (Surgeon) 
Gowland, Jacob .... 

Kent, S 

Wilkinson, J. E 

Tomkins, J. (Surgeon) . . 
Bompas, G. G. (M.D.) . . 

lies, A 

Middleton, H. (Mrs.) . . . 
Riches (Surgeon) .... 
Scales, G. J. (Surgeon) . . 
Twynam, J. TM.D.) . . . 
Gilliland, J. (Surgeon) . . 
Millard, S. (Surgeon) . . . 

Rix, Jane (Mrs.) .... 



Mott 

Smith, N. (M; D.) and Mc"! 

Intosh, D. (M.D.) . . . / 
MaUam, Richard (Surgeon) . 
Gough, (Surgeon, Governor of "1 

House of Industry) . . / 
Jacob, James 



Gillett, W. E. (Surgeon) . 

Terry, Stephen (Surgeon) 

Rowley, T, (M.D.) . . 

Shaw, James (Surgeon) . 

Gibbs, M. (Mrs.) . . . 

Lewis (Messrs.) . . . 

Finch, W. (M.D.) . . 

Finch.W. C. (M.D.). . 

Langworthy, C. C. (M.D.) 
Phillips, T. (Surgeon) 

Spencer, C. F 

Willett, R 



Ricketts and Hastings, (Messrs) 

Surgeons 

Martin, James 

Beall, Jos 

Casson, Richard (Surgeon) . 

Gofton, Robert 

Hornby, B. (Surgeon) . . 
Taylor, C. A. (Miss) ; . . 

Taylor, Isaac 

Walker and Matterson, "] 
(Messrs.) Surgeons . . J 



Green Hill House 

Workhouse, Stoke Damere],De- "1 

vonport j 

Plympton House, Plympton St. 1 

Mary J 

West Auckland 

Bensham, near Gateshead . 

Wreckenton, do 

Gateshead Fell 

Dunston Lodge, Whickham . 
Maldon Lane, Witham . 
Fishponds, Stapleton, near Bristol 

Fairford 

Grove Place, Nursling . . . , 
House of Industry, Carisbrooke , 
Hilsea Asylum, Portsea Island . 
Lainston House, Winchester . 

Hereford 

Whitechuich, near Ross . 
West Mailing Place, West Mai- "1 

ling J 

Haydock Lodge, Winwick . . 
Newcastle-on-Tyne, Lunatic T 

Asylum J 

Hook Norton 

Morda, Oswestry • • , . . 



House of Industry, Kingsland, "1 
Shrewsbury J 

Fairwater House, Staplegrove, 1 
near Taunton .... J 

Bail brook House, Bath Easton . 

Sandfield, Lichfield . . 

Belle Vue House, Ipswich 

Haugh House, Packwood . 

Duddeston Hal], near Birmingham 

Laverstock House, Salisbury . . 

Fisherton House, Fisherton, 1 
Auger J 

Kingsdown House, Box . . . 

Belle Vue House, Devizes . . 

Fontbill GifFord, Hindon . . . 

Fiddington House, Market La- | 
vington J 

Droitwich 



Gate Helmsey, near York . , 
Moo Cottage, Nunkeeling, near "1 
Brandsburton .... J 
Hull and East Riding Refuge . 

Southcoates, Hull 

Dunnington, near York . . . 

Hessle, near Hull 

Acomb, near York 

Heworth, near York . . . 



Weekly 
Charge for 
Paupers. 



(t) 



(b) 10 6 

(b) 
(a) 



6 to 7 
8 

7 to 8 

8 
(a) 8 


10 
8 to 9 



ll 



1 



(a) 



S 9 to 9 6 
9 
(a) 10 to 12 
(a) 10 



m. t. 

(a) 9/6 9 

(b)8/6 to 9 
2 6t 

(b) 6 to 10 
(b) (a) 

8 9 
(b) 9 (a)10 



(a) 10 

(a) 7/6 to 8 

8 

8 to 9 

8 







7 



(a) 

:i 

(a) 8 
8 

(a) 9 

(b) 8 



(b) 
(b) 
(a) 

b) 



8 
8 
5 to 9 
8 



b) 8/6m.8f. 
8/6m 
7/6f. 



(b) 8/6m. X 



JGlamorgan I Leach, R. V. (Surgeon) 



WALES. 
I Brilton Ferry, near Swansea | 



1 I 2 



(b) Not including clothes. (a) Including clothes. * Same as for O'jt Couity Paupers at County Asyim. 

■f Estimated weekly cost. 



APPENDI};: B. 



COUNTY ASYLUMS. 



ACCOMMODATION AND COST OF ERECTION. 

♦ 

'BEBYOKD.— Opened August, 1S12.— Pauper. 

Land 9 Acres. 

Cost . . . . . Total Cost of Buildings, Furnishing, and 

Land, 20,500/. 
Accommodation . 90 Males, 90 Females. Total, 180. 

Average Cost per head, 114/. 



CHESTER. — Opened August, 1829. — Private and Pauper. 

Land . . . . 10|^ Acres. 

Cost .... Total Cost of Buildings and Land, &c., origi- 
naUy about 28,000/. 

Accommodation . Originally built for 96 ; viz. — 10 Male and 
10 Female Private Patients, and 38 Males and 38 Female 
Paupers, to each of whom was assigned a separate Sleeping Room, 

The Sleeping Rooms in the Pauper Galleries are 10 ft. by 8 ft,, 
and from 11 ft. 3 in. to 12 ft. in height; and two Beds are now, 
for the most part, placed in each Room, affording present accom- 
modation for 152. 

Average Cost per head to County. — Calculated on first Cost of Erec- 
tion and original Accommodation . . £292 

■ on present Accommodation . . i6184 



215 



CORNWALL.— Opened IS20.— Private and Pauper. 

Land. — Acres, presented by the Corporation of Bodmin. 
Cost of Buildings, not including FurnisMng : 

Original Building .... £15,000 
New ditto • 3,780 



Total to present time . . . £18,780 

Accommodation . , Original part . 112 

„ „ Additional Buildings 60 



Total, Pauper, 129 ; Private, 43 . . 172 

Average Cost per head : On first Accommodation . . £134 
„ „ On present Accommodation . £109 



DOUBET.— Opened August 1st, IS32.— Pauper. 

Land . . • 8| Acres. — Land, with original House, pre- 
sented hy F. J. Browne, Esq., who also vested 4000/. in the 
Funds, the Dividends to he appHed towards the Annual Charges 
of the Estahhshment. 
Cost of Building . . . ' . . £13,156 
Furnishing .... 1,561 



Total £14,717 

Accommodation . 51 Males, 62 Females. Total, 113. 
Amount of Subscriptions ;. . . . £3,155 
Defrayed by County . . . . 11,562 

£14,717 

Average Cost per head . On total Outlay, £130 
„ „ Borne by County, £102 



216 



QLOV CENTER.— Opened 2^th July, IS23.— Private and Pauper, 

Land . . Original Purchase . 7 Acres for £1,660 

Building, &c. First Cost of BuUding £38,500 

Cost . . „ Fittings 2,696 7 

■ 41,196 7 



Total first Cost . . . £42,856 7 

Males. Females. Total. 
Original Accommodation . Private .30 30 60 

„ . Pauper . 30 30 60 



Total . 60 60 120 

First Cost per head . . . £357 

How defrayed (as well First Cost, as of Additions) : — 

^-jj by Subscription Fund, or Charitable Institution. 



U » County 



f of Gloucester, by Rate. 



¥V " City 

Additional Land . . Second Purchase . 7 Acres for £1,250 
„ . . Third Ditto . . | „ 450 



N.B. — Ten Acres also Rented. 
Total Cost to present Time: — 



£1,700 



Buildings, about .... 


£44,000 


Furniture, Fittings, and Apparatus . . 


4,000 


Land . . . . . 


3,360 


Total . . . 


£51,360 


Males. 


' Females. Total. 


Present Accommodation . Private . 32 


39 71 


„ „ . Pauper . 95 


95 190 


Total . 127 


134 261 


Total Cost of Asylum, defrayed by — 




Subscription Funds 


£20,544 


County ...... 


28,248 


City 


2,568 



£51,360 



217 

Average Cost per head for Paupers borne by County and City, 162/. 
The sum annually paid by the County and Subscribers for 
Repairs and Alterations is about 800/., ^^ of which is paid by the 
Subscribers. 



KENT. — Opened \st January, \2iZZ.— Pauper. 

Land . . 37 Acres . . 6,000/. 
Total Cost to present Time, of Buildings, Furniture, and 



Land .... 


. 


. 64,056/. 




Males. Females. Total. 


Accommodation . Wards 


. 137 137 


274 


„ Injfirmaries 


13 13 


26 


Total . 


. 150 150 


300 


^ . - rMales 
In smgle rooms < ^ 

I. Females 


. 102 




. 102 






204 




Average Cost per Head . 


. 213/. 




Details of Cost of Asylum : — 






Original Buildings, Walls, 


&c. (about) . £35,000 


Land (37 Acres) 


. 


6,000 


Fiu-nishing, Apparatus, Baths, &c. . . 


9,000 


Hospitals 


. 


2,056 


New Wings 


. i 


12,000 


Total as above 


£64,056 



LANCASTER.— OjoeTzec/ 2m July, 12>IQ.— Pauper. 
Land . . . .15 Acres. 
Of this Land Five Acres, first purchased, are within the Boundary 
Wall, about one-fourth being covered by Buildings. The remaining 
Ten Acres are cultivated as a Farm. They are separated from 
the Asylum by a public road, and the ground is swampy. 

Thirty Acres from the adjoining Moor have been recently 
purchased under the powers of a local Act obtained in 1843. 



218 



Total Cost of Asylum to 23rd March 1843 :— 

Building . . . £91,848 11 3 

FurnisMng . . . 5,487 9 3 

Repairs and Sundries . 2,232 12 3 

15 Acres of Land . . 1,127 4 



Total Charge to County £100,695 16 
Accommodation . No. of Beds in Apartments 



9 

/Males 295 
\Females 298 



Total of Beds in Apartments 

Of these there are in Single Rooms . 

** Douhle-bedded 

" Three Beds each 

•* Four " 

" Five 

" Six 

" Twelve " 

" Thirteen " 

" Fourteen " 

" Fifteen " 

" Sixteen " 

. " Nineteen " 

*• Twenty-one " 

" Thirty-one " 



593 



Males. 

91 



66 

4 
20 



36 
26 
14 



Females. 

53 

56 
42 

10 
12 

26 

15 
32 



38 — 

— 21 

— 31 



Total Beds . . . 295 298 

Total No. of Rooms . . 126 106 

Average Cost per head, 170?. 
N.B. — The actual numher of Patients for whom accommodation is 
provided is ahout 620. 



219 



LEICESTER.— Oj»ewec/i»f«y 10, 1S37. —Private and Pauper. 

Land ... 8^ Acres. 

First Cost of Asylum : — Bxiildings, Fences, Plant- 
ing, Wells, Pipes and Water-works, Ventilation 
and Warming, Roads, &c £16,893 12 

Furnishing and Baths . . . . 2,166 11 3 

Land . . 2,070 10 



Total .... £21,130 13 3 
How defrayed: — Donations and Subscriptions, 

with Proceeds of Old Institution, Buildings, and 

Funded Property £7,375 3 5 

Charge on County Rate .... 13,755 9 10 

Total as above . . .£21,130 13 3 

Males. Females. Total. 
First Accommodation. — In single Sleeping rooms 28 28 56 
Dormitories,6 to 10 Beds each . . 24 24 48 



52 52 104 

Average Cost per head. Private and Pauper . . 203/. 

Cost of additional Buildings and Furniture, about . 6,500/. 

Total Cost of Asylum to present time, about . . 27,630/. 

Present accommodation . 76 Males, 76 Females. Total 152. 

Average Cost per head, about . . 180/. — This is calculated 
upon the entire outlay and total accommodation. Assuming the 
accommodation for Paupers to be equivalent to their actual 
number on 1st January, 1844, viz. 104, and charging the 
County with the Cost of the additional Buildings, the average Cost 
per head to the County for Paupers will be 194/. 



MIDDLESEX. 
Hanwell. — Opened I6tk May, 1831. — Pauper. 
Land, 53 Acres. 

The original Cost appears to have been 124,456/. 14«. M.y out of 
which the following Payments were made : — 



220 

For 44 Acres of Land £10,925 

For the original Buildings . . . . 77,271 10 

For Furniture, &c 8,806 16 

The additional Buildings erected in 1837 appear to have cost 

20,000/. 
We have not obtained the particulars of the costs of this Asylum, 
but were informed by the Accountant that it has amounted to 
160,000/. This smn does not include 36,000/., which has been 
also paid in different annual sums by the County since the 9th of 
July 1835, for Furniture, Fittings, and Labour about the Asylum, 
and which now annually amounts to about 4,000/., and is exclu- 
sive of what is paid by the Parishes. The sums which appear to 
have been paid on this accoimt in the year 1843, seem to have 
amounted to 6,637/. 12^. 
Accommodation . . 1,000 Patients, Male and Female. 
Average Cost per head . 160/. 



NORFOLK.— Ojoewerf 18^^ May, ISU.— Pauper. 

Land . . 4^ Acres. 

Cost of Asylum to present time : Building, Fm-nishing, and Land, 

(say) 50,000/. 
Accommodation . . . . . Males 110 — Females 110. — 

Total 220. 
Average Cost per head ... 227/. 



NOTTINGHAM. 

Land 8 Acres. 

Total Cost of Asylmn to present time : — 

Buildings and Furniture, Apparatus, &c., about £34,000 
Land, Planting, &c 2,800 

Total £36,800 

towards which, about 6,800/. appears to have been contributed 
in the shape of legacies, benefactions, and parochial collections. 



221 

Present Accommodation . Males 85 — Females 85. — Total 170. 

Averao-e Cost per head . . 220^. — This is estimated on the total 
outlay and amount of accommodation. Assuming the Asylum to 
afford accommodation, according to the existing arrangement, for 
125 Paupers, the number 1st Jan, 1844, and 30,000/. as the total 
outlay borne by the county, the average cost per head for Paupers 
will be 240/. 



STAFFORD. — Opened 1st October, 1818. — Private and Pauper. 

Land 30 Acres. 

Cost of Erection and original Accommodation : — The total original 
cost of Land, Buildings, and Furniture, appears to have been 
about 36,500/. ; whilst the Asylum was calculated to accommo- 
date 120 Patients only. 

Present Accommodation — 250 Males and Females, viz. about 65 
private Patients, and 185 Paupers. Much additional accommodo- 
tion for Paupers has been obtained by converting the Gralleries, 
by means of folding partitions, into Dormitories. The outlay on 
account of additions and improvements cannot be stated. 



SUFFOLK. — Opened \st Jan., 1829. — Almost exclusively Pauper. 
Land 30^ Acres. 

Cost of Buildings, Land, «fec. — 

Purchase of House of Industry and Land . . ^8,000 

Expense of conversion into an Asylum, Furnishing, &c. 22,000 

Extension of Wings, &c. . . . . say 2,000 

Total .... £32,000 



222 



Accommodation .... 90 Males — 90 Females. — Total 180. 

Average Cost per head . 177/. 

N.B. — Additions and improvements are in progress, by which 

accommodation will be made for 30 more Patients. At present 

the Asylima is much crowded. 



SURREY.— Ojoewerf Utk June, ISil.— Pauper. 

Land 97 Acres. 

Cost of Buildings, Land, <fec. — 

Buildings £67,467 1 10 

Furnishing, &c., and preliminary expenses 7,514 19 3 

Land, &c . 8,985 9 5 



Total . . £85,366 19 1 

Accommodation . . . Males 180 — ^Females 180. — Total 360. 
Average Cost per head . 237/. 



YORKSHIRE, W. RIDING.— (Wakefield.) 

Land. — In addition to Pleasure Garden and Grounds, 40 acres cul- 
tivated as Farm and Kitchen Garden. 
Accommodation .... Originally built for 150 

Additional Wings 154 



304 
Actual Numbers accommodated . . 420 

Total Cost of Land £8,846 

Buildings, Fittings, &c 38,000 



£46,846 
Average Cost per head, on -present Numbers . . £111 



APPENDIX C. 



CONDITION OF PAUPER PATIENTS ON ADMISSION. 



COUNTY ASYLUMS. 

Bedford . At the Asylum for the County of Bedford we were 
informed that the general condition of the Paupers 
■was much improved of late, and that they were now 
brought to the Asylum soon after the attack of 
Insanity. 

Chester . The information obtained at the Chester County Luna- 
tic Asylum was, that " The Paupers are brought in 
a very bad state, in filth and in rags, and, from too 
long delay, in a state when there is little or no 
chance of cure." 

Cornwall . At the Asylum for the County of Cornwall it was 
stated by the Medical Superintendent, that in a large 
proportion of cases admitted during the year 1842, 
owing to long detention by friends or parishes, the 
prospect of recovery had been entirely precluded ; and 
that it had been the custom in the County of Corn- 
wall not to send a Patient to the Asylum until he 
had become, either from dirty habits, or dangerous 
propensities, unmanageable in a Workhouse, or in 
lodgings. The attention of the Magistrates of the 
County had been called to the subject in the last 
Annual Report of the Asylum. 

Dorset . The Medical Superintendent of the Asylum for the 
County of Dorset has for some time past directed 



224- 

the attention of the Magistrates of that County to 
the condition in which Pauper Lunatics are sent to 
the Asylum. Out of thirty-seven cases admitted 
during the year 1842, only six were received within 
three months after their being first attacked, eight 
within twelve months, five had been insane between 
two and five years, and the remaining Patients had 
been afflicted from seven to thirty years. Those 
admitted within three months after the first attack 
of the disease had all recovered, and were discharged 
within four months from the time of their admis- 
sion, excepting one female, aged seventy-five, who 
had been for some time in a state of senile imbeci- 
lity. Amongst the evils complained of in relation to 
this subject, is a habit on the part of the Clerks and 
Officers of Unions, after they have received orders 
from Magistrates to send Lunatics into the County ■ 
Asylum, of retaining them at their houses upon a 
temporary mitigation or suspension of their attacks, 
and of afterwards sending them to the Asylum upon 
a return or an increase of their disease. In confirm- 
ation of this complaint, the particulars of two Cases 
were given, in which the Officers of Unions had 
kept Pauper Lunatics in lodgings for several months 
after Orders had been received from the Magistrates 
to remove them to the County Asylum. In both cases 
the Officers were subsequently obliged to send the 
Paupers to the Asylum. One case occurred in April, 
and the other in October, 1843. The fuU details of 
these cases are in the Office of the Metropolitan 
Commissioners, and the attention of the House of 
Commons was called to one of them in the last Ses- 
sion of Parliament by Lord Ashley. 
Gloucester. All the Paupers who are now received are either sent 
from the Workhouses, or are found wandering 
about ; and in general they are not now detained 
more than a few days in the Workhouse before they 



225 



are removed to the Asylum. Their condition when 
first admitted is considered to be much more debi- 
litated than it used formerly to be, a change which 
the Superintendent ascribes to the prevailing pres- 
sure of the times, and the increase of distress and 
extreme poverty among the Poor. 

Ki3NT . The Paupers are generally brought to the Kent Asy- 
lum in a very advanced stage of their disease. 

Lancaster . At the Lancaster Asylum the statement made was, 
that nearly all the Patients admitted into the Asylum 
were brought from Workhouses, where they had in 
general been detained a considerable time, and conse- 
quently the malady had become more or less con- 
firmed, thus diminishing the probability of re- 
covery. 

Leicester . The information obtained at the Leicester Asylum was 
that the condition of Pauper Lunatics generally, 
when admitted, was most unfavourable. The majo- 
rity of cases are of a chronic description, from deten- 
tion elsewhere, and treatment totally inadequate to 
their condition. The consequence was stated to be 
confirmed disease, a low average of recoveries, and a 
large amount of Incurables. " This state of things 
" to use the words of the Superintendent, is produc- 
" tive of irreparable mischief to the poor Lunatic, and 
" in a pecuniary point of view entails on his Parish 
" a very serious expense, which in most cases might be 
" obviated by early and efficacious treatment in the 
" recent stage of the malady, to say nothing of the 
" gratification it would afford to every rightly cousti- 
" tuted mind, to restore a wretched Maniac to health, 
"to reason, and to a wife and family dependent upon 
" him." 

Middlesex . From the 1st of January to the end of March, 1844, 
forty cases were refused admission at this Asylum, 
so that there is in reality little chance of recent 
cases gaining admission at Han well. 
Q 



226 



Norfolk . The result of our inquiries at the Norfolk Asylum 
was, that many Patients, Males and Females, were 
admitted in very feeble health, and suffering 
from the effect of pressure; but that, generally 
speaking, they were not detained long in Work- 
houses. 

Nottingham Such has been the bad condition in which Paupers 
have been brought to this Asylum, that Dr. Blake, 
the late Physician, presented a petition to the House 
of Lords, calling their attention to the incurable 
state in which Paupers had been sent, from being 
kept away long after the commencement of their 
disease. The result of our latest inquiries at this 
Asylum has been that, since the new Poor Law 
came into operation, an increased reluctance has 
been exhibited on the part of the parish authorities 
to send their poor to an Asylum, and that the 
Patients frequently come in a very exhausted and 
debilitated state. Great advantage is said to be 
taken of the use of the word " dangerous" in the 
45th section of the Poor Law Amendment Act ; 
and many curable cases are detained in Union 
Workhouses in the rural districts. 

Stafford . At the Stafford Asylum we were informed that the 
Paupers were generally sent soon after the commence- 
ment of the disease, but often very dirty, sometimes 
in manacles, and with scarcely any clothing. 

Suffolk . At the Suffolk Asylum we were told that it had 
long been a source of complaint that Patients were 
sent to the Asylum wretchedly fed and wretchedly 
clad, and occasionally in an exhausted and almost 
dying state. This, however, it was said, had not 
been so much the case in recent times as formerly. 
Nevertheless, the Patients are still rarely received in 
an early stage of their malady. Cases have occurred 
in which Patients have been brought to the Asylum 
in improper conveyances, and not sufficiently pro- 



227 

tected from the weather, and where "death was pro- 
bably accelerated by the journey and consequent 
exposure." 

So aREY. . At the Surrey Asylum it was stated that the Paupers 
were frequently detained too long in Workhouses, 
and under the care of their friends, especially in 
recent cases, so as to afford little chance of cure 
or benefit from medical treatment. They are sent 
to the Asylum in some cases to die. 

York, W. Riding. We were informed at the Asylum at Wakefield, 
that the Paupers were very commonly retained so 
long in the Workhouse as to leave little chance 
of recovery. The reason assigned was said to be 
obvious. In the Asylum 7s. a week is paid for 
their maintenance; while in the Workhouse they 
are maintained for less than half that sum. 



LUNATIC HOSPITALS RECEIVING PAUPERS. 

Lincoln. . The House Surgeon of the Lincoln Asylum stated 
that a great number of Paupers were sent into the 
Asylum in a state of mental and bodily health 
which rendered all chance of their recovery hopeless. 
He instanced three cases, in one of which the 
Patient died within four days ; in another within 
twenty-five days, and in the third within eight 
days after admission ; and in each of these Cases 
the Patient had been previously kept some time in 
the Workhouse. In one instance, Mr. Smith, the 
House Surgeon, refused to admit a Patient brought 
to the Asylum in a dying state, without the sanction 
of one of the Physicians. Dr. Charlesworth, one 
of the Visiting Physicians, entirely confirmed this 
statement, and called our attention to the remarks 
upon this subject in the Report of the Asylum 
for the year 1842. 
Q 2 



228 

Northampton. The Medical Superintendent of the Northampton 
Asylum, stated that some few of the Unions which 
send their Paupers to the Asylum acted with libe- 
rality and sent them at the commencement of 
their malady ; but that the greater number of the 
Unions either keep them in the "Workhouses or 
farmed them out to other poor people at a small 
sum, in some cases not exceeding 2*. 6d. a week, 
until they were in a state, in which, either from 
becoming destructive of their clothes or dangerous 
to the persons about them, they could no longer be 
kept with economy nor safety ; and that thus they 
arrived at the Asylum when their bodies as well 
as minds were beyond the reach of cure or remedy. 



LICENSED HOUSES RECEIVING PAUPERS. 



Durham . In this County the Paupers are stated to be sent to 
Asylums earlier than they used to be, in 1843. 

Devonshire. At Plympton St. Mary, near Plymouth, the Patients 
are generally sent in a bad state. They are the 
refuse of the Workhouses, many of them are Epi- 
leptics, and upon an average eight out of ten are 
incurable. 

Gloucester. Fairford — Some of the Paupers have been sent to this 
Asylum in a very bad state, and particularly during 
the last year. The late Medical Attendant left an 
entry in the Medical Register, stating that many 
of the Paupers had entered the Establishment 
who were not suffering from any acute disease, 
but had the functions of life so languidly performed 
that it constituted, in a great degree, their mental 
malady ; the unsoundness of mind consisting more 



229 



in the want of power than in any perversion of tlie 
reasoning faculty, or in any delusion. Thirteen 
cases were instanced in which persons died in the 
year 1842 very soon after their admission into the 
Asylum, having been brought there in a very bad 
state of bodily health. — 1843. 
Hereford . Hereford Asylum. — The Pauper Patients in Mr. Gil- 
liland's opinion are kept too long in "Workhouses 
before being sent to the Asylum to give tliem a fair 
chance of recovery. 
"Whitchurch. — Paupers are frequently sent in a very 
bad condition, much reduced, and under great 
exhaustion. 
Middlesex . AtDr.Warburton's, at Bethnal Green, not one out often 
Paupers who are admitted arrive in a curable state. 
Hoxton. The information received from this Asylum is, 
that in the majority of instances the Pauper Patients 
received have imdergone some previous treatment, 
though some cases are quite recent. The greater 
number of chronic cases admitted have been for some 
time inmates of Workhouses. 
Northumberland. Newcastle. — Paupers are received at an earlier 
stage of disease than they used to be. They are 
frequently brought ill- clad and very dirty. 
Gateshead Fell. — Paupers are received at an earlier 

stage of their disease than formerly. 
Dunston Lodge. — Paupers are received in a better state 
and earlier than they used to be. A female, how- 
ever, had, immediately previous to one of our visits, 
been received who had been Insane twenty years, 
and was sent because she was noisy and trouble- 
some. 
Oxford . Hook Norton. — The majority of the Paupers sent inta 
the Asylum are old cases which have previously been 
kept for some time in the Workhouse, a circumstance 
which is considered to operate unfavourably to their 
recovery. 



230 



Shropshire. Kingsland, near Shrewsbury. — The Paupers are not 
sent to the Asylum in so bad a condition as formerly. 
They are even now kept too long, so that the chance 
of cure is in many cases small. 
Somersetshire. Fairwater House, near Taunton. — The prospect of 
recovery as regards the Tauper Patients is but 
slender, their cases being generally of long standing 
before their admission. 
Bailbrook House, near Bath. — The condition of the 
Paupers who come from the Bath district is such as 
in general to afford little prospect of recovery. From 
other districts the prospect of recovery is now more 
favourable, because they are usually sent on the first 
outbreak of the disease. 
Hampshire . Hilsea Asylum, near Portsmouth. — The Paupers are 
frequently sent in an advanced stage of their disease, 
and in a bad state. They are usually sent, in the 
first instance, to the Parish Workhouse, and are 
kept there as long as they can be managed, and 
when they become violent or dirty, they are removed 
to the Asylum. 
Nursling, near Southampton. — The Insane Poor are 
not unfrequently detained improperly in "Work- 
houses, and many of them come in a state of great 
debility and exhaustion from having refused food. 
Suffolk; . Belle Vue House, near Ipswich. — Pauper Patients are 
generally detained as out-door Paupers by their 
friends until they become unmanageable. The blame 
is considered not to rest so much with the Relieving 
Officers of Unions, as with the friends under whose 
care the Pauper Lunatics are placed by the Parish 
Authorities. 
Waravick . Duddeston, near Birmingham. More than half the 
Patients under the care of Mr. Lewis belong to the 
parish of Birmingham, where the practice is to detain 
them in the lunatic wards of the Workhouse until 
they become unmanageable, when they are sent to 



231 



Duddeston. It is stated, not only that the worst 
cases are sent to that Asylum, but that those who are 
in a state of improvement are prematurely removed 
back to the Workhouse. 

WiLTsHiKE . Fisherton House, near Salisbury. — The Paupers are 
frequently kept, either at their own houses or in 
Union "Workhouses, so long after the attacks of their 
disease that their chances of recovery are much 
diminished. 
Laverstock House, near Salisbury. — Since the 
establishment of Unions, Paupers are sent in an 
earlier stage of their disease than they used 
to be. 
Belle Yue, Devizes. — Some of the Paupers are brought 
in a very bad state, being detained as long as they 
are manageable, or can be kept cleanly. Many from 
Wales are violent, and bad cases when they arrive. 

Worcester . Droitwich. — Paupers are very frequently sent in an 
extremely bad condition, having been previously 
detained for a considerable time in Workhouses, 
and then brought to the Asylum in carts, bound 
with cords. 

Yorkshire . Gate Helmsley. — At our first visit the information was, 
that Paupers were frequently brought in an advanced 
stage of their disease, so as to afford little prospect 
of recovery. They are said to be now brought in a 
better state. 
Dunnington. — The Paupers are often sent in a very 
filthy state^ bound with cords, and otherwise re- 
strained. In some cases the Patient has been kept a 
long time after the commencement of the disease 
before he is brought to the Asylum. In others 
he is brought soon after the commencement of his 
illness. 

Hull . , . Refuge, Hull. — It is stated that the Paupers are 
admitted in the last stage of disease, and that little 
medical history of the cases can be obtained from 



232 

Parislies. As an instance of the condition in which 
they are sometimes brought to the Asylum, the case 
of a female pauper was mentioned, who was received 
in November last, from Blighton, near Gainsborough. 
She was in the last stage of phrenitis, was conveyed 
to the Asylum wrapped up in a blanket, which was 
thrown over her head ; and she was, when received, 
in a profuse perspiration. She died within eight 
days of admission. The Parish Officers of Hull 
are said to have been more cautious in this respect of 
late years than formerly, partly, as it is believed, 
in consequence of a male Pauper Lunatic detained 
in the Workhouse having, in a paroxysm of mania, 
stabbed three or four of his fellow paupers, one of 
whom died of his wounds. 



WORKHOUSES. 

Redruth . In the Union Workhouse at Redruth, visited on the 6th 
October, 1843, there were 41 Insane Persons, besides 
5 others of weak intellect, and unable to take care of 
themselves, but who had not been returned as insane 
in the return of Lunatics made to the Clerk of the 
Peace in the year 1842. Out of these 41 Insane 
Persons there were 6 Idiots. Several of the women 
were stated to be occasionally violent; one of them 
sometimes requiring handcuffs, a second having 
attempted to escape, and a third to break windows. 
Several had delusions: one female, who had at- 
tempted to destroy herself, fancied her body not to be 
her own. Amongst the men, some were at times 
violent; others who had been very violent were 
become enfeebled. It was stated that if any of the 
men required restraint it would be employed . One 
woman was extremely dirty, and addicted to dis- 
gusting habits. 



233 

Bath . . lu the Union AVorkhouse at Bath, visited on the 20th 
of October, 1843, there were 21 Insane Persons; 
12 Males, and 9 Females. Of these, 3 were subject 
to fits, and 3 were Idiots — one woman was in bed 
and had on a strait waistcoat, and was constantly 
under such restraint. Another woman was excited 
and in bed ; the rest of the Lunatics appeared 
in tolerable health. One man had been in the 
House since the 22nd of June previous, and from 
his own statement, confirmed by the Master of the 
House, it appeared that he had had no medicine or 
medical treatment since his admission, although his 
case appeared to be one that was susceptible of 
improvement by proper remedies. 

Leicester . In the Union "Workhouse at Leicester, visited on the 
6th October, 1843, there were 30 Insane Persons, 
namely 11 Males and 19 Females. Of the males, 
"W. K. was a noisy Maniac, very cunning, and occa- 
sionally striking the other men in the ward. P. R. 
was subject to maniacal attacks, during which he 
was placed in a strait waistcoat. He was raving mad 
about two months before our Visit, and was constantly 
fastened to his bed at night to prevent him from injur- 
ing or annoying the other inmates. A. H. was violent 
and passionate, and tried to cut others with knives ; 
and all these persons were dangerous. Amongst the 
other cases, were, J. L., an Epileptic ; J. D. a case 
of Melanckolia ; J. G., formerly in the Asylum, 
and still Insane, noisy, and abusive. The rest of the 
Males of this class appeared to be either harmless 
Idiots, or in a state of mental imbecility. The three 
most dangerous of the females were, C B., admitted 
June 12th, 1839, a destructive and dangerous Idiot; 
M. H., admitted 23rd of February, 1839, an abusive 
and dangerous Lunatic. She was brought to the 
AYorkhouse in a state of violent excitement, by two 
policemen. M". A. R., admitted 24th of February, 



234 



1841, a quarrelsome and dangerous Idiot, once 
knocked out the teeth of a child. To these may be 
added the following, as properly coming within the 
description of dangerous Lunatics : — M. B., a sullen 
ill-tempered person, who refused to be employed, and 
< had threatened, when at home, to kill her mother. 
A. W., in the "Workhouse three years, an abusive 
Lunatic, who had occasionally struck most of the 
women in the ward, particularly a paralytic patient 
who could not defend herself. J. S., an irritable mad 
woman, who threw knives at those with whom she 
happened to have a dispute. E. H., a violent, iras- 
cible person, subject to maniacal excitement, and 
dangerous when irritated. She had been twenty-six 
weeks in the County Asylum, having become unman- 
ageable at home after the death of her mother, sixteen 
years ago, — and was said to strike the inmates mali- 
ciously. A. H., a harmless Lunatic, with delusions, 
was most improperly sent to the Workhouse, instead 
of the Asylum, four years ago. Besides the above, 
tliere were in the House 6 quiet female Lunatics, all 
confirmed cases, and 5 Idiots. There were in the 
House altogether, 3 Males and 9 Females, properly 
to be classed as dangerous Lunatics. 

PoRTSEA . In the "Workhouse at Portsea, near Portsmouth, 
visited on the 28th of August, 1843, there were 26 
Lunatics ; 15 Females, and 11 Males. Of these, 7 
were Epileptics, and 2»Idiots. Many of the Patients, 
although not strictly speaking, imbecile persons, 
were individuals of weak intellect. Some of them, 
however, were decidedly Insane, and occasionally 
violent and unmanageable unless restrained, and some 
of them were labouring under delusions. 

Birmingham. In the Workhouse at Birmingham, visited on the 
29th of September, 1843, there were 71 Lunatics. 
Amongst them was an unusual proportion of Epi- 
leptics, namely, 11 Males and 16 Females. Several 



235 

of these were Idiots : others were subject, after their 
paroxysms of Epilepsy, to fits of raving madness, or 
Epileptic furor, during which they were stated to he 
excessively violent. Besides these, there were several 
patients who were occasionally under great excitement, 
and furiously maniacal. Two of the females had strong 
suicidal propensities, and one of them had attempted 
suicide. There is no class of persons more dangerous 
than are those Epileptics who are subject to attacks 
of Epileptic furor or delirium. It is well known 
that many fearful homicides have been perpetrated 
by persons afflicted with this form of mental disease. 



APPENDIX D. 



List of Counties having County Lunatic Asylums exclusively 
for Paupers, with the numbers of Pauper Lunatics in each 
county, and the numbers for whom there is accommoda- 
tion in each Asyliim. 



Pauper Lunatics. 



Numbers 

in 
County, 

1842. 



Accommodation. 



Numbers 
for whom 
there is. 



Numbers 

for whom 

there is 

not. 



Bedford. 

Lunatics in County 

Accommodation in County Asylum 
Chester. 

Lunatics in Unions 

Not in Unions . . . . , 

Accommodation in County Asylum for 
Dorset. 

Lunatics in County . . . . 

Accommodation in County Asylum for 
Kent. 

Lunatics in Unions . . . , 

Not in Unions ... . . 



135 
180 

2731 
23/ 
110 

227 
113 

465 
13 

478 
Accommodation in County Asylum for 300 
Lancaster. 

Lunatics in Unions . . . .979 
Not in Unions 123 

1102 
Accommodation in County Asylum for 600 
Middlesex. 

Lunatics in Unions . . . 884 

Not in Unions . , ... 735 

I 1619 

Accommodation in County Asylum for 1000 

Norfolk. 

Lunatics in Unions . . . .401 
Not in Unions 69 

470 
Accommodation in County Asylum for 220 

Suffolk. 

Lunatics in County . . . .361 

Accommodation in County Asylum for 

Surrey. 

Lunatics in Unions . . , .521 
Not in Unions 70 

591 
Accommodation in County Asylum for 350 
York, West Riding. 

Lunatics in Unions .... 664 
Not in Unions 363 

1027 
Accommodation in County Asylum for 420 



155 

296 

227 

478 

1102 

1619 

470 
361 

591 

1027 



141 
155 

113 
300 
593 

1000 

220 
180 

360 
420 



141 



114 



178 



509 



619 



250 



181 



231 



607 



* According to the Poor Law Returns for 1842; since which the numbers of 
Pauper Lunatics, (as will bo seen by reference to Appcndi.x F), and consequently 
the deficiency of accommodation in Asylums have increased. 



237 

List of Counties having County Lunatic Asylums for Paupers 
in union with Subscription Asylums, with the numbers of 
Pauper Lunatics in each County, and the nmnbers for 
whom there is accommodation in each Asylum. The 
numbers of Pauper Lunatics belonging to Parishes not 
in Unions have been calculated at one in a thousand of 
the population, according to the Census of 1841. 



Pauper Lunatics. 


Numbers 

in 

County. 

1842. 


Accommodation. 


Numbers 
for whom 
there is. 


Numbers 

for whom 

there is 

not. 


Cornwall. 

Lunatics in Unions .... 273 
Not in Unions ... .24 

Total Lunatics . . 297 
Accommodation in County and Sub- 1 , „„ 
scription Asylum for Bodmin . J 

Gloucester. 

Lunatics in Unions .... 398 
Not in Unions . . . .100 

Total Lunatics . . 498 
Accommodation in County and Sub- 1 ,^^ 
scription Asylum for . . . J 

Leicester. 

Lunatics 244 

Accommodation in County and Sub-"] ,^^ 
scription Asylum for . . .J 

Nottingham. 

Lunatics in County and County ofl „^, 
Town 1 ^bl 

Paupers in County and Subscription T 

Asylum for County and Town in V 125 
1842 J 

Stafford. 

Lunatics in Unions , . . . 384 
Not in Unions ... .68 

Total Lunatics . .452 

Paupers in County and Subscription "1 , -- 

Asylum in 1842 . . •/ '' 


297 

498 
244 

261 

452 


129 

190 
104 

125 
185 


168 

308 
140 

136 

267 



?38 



List of Counties in England, with the numbers of Pauper 
Lunatics, and the total accommodation for them in Public 
and Private Asylums in each County. The numbers of 
Pauper Lunatics as to that part of the population which 
is not comprised in Unions have been calculated at one 
in a thousand of the population, according to the Census of 
1841. 



Pauper Lunatics and total Accommodation, 


Numbers 
in 


Accommodation. 


Numbers 


Numbers 


in Public and Private Asylums. 


County, 


for whom 


for whom 

there is 

not. 




1842. 


there is. 


Bbdford. 








Lunatics in County . . . .135 








Accommodation in County Asylum for 180 


135 


180 




Berkshire. 








Lunatics in County .... 241 


241 


. . 


241 


Buckinghamshire. 








Lunatics in County . . . .127 


127 


. . 


127 


Cambridge. 








Lunatics in County .... 159 


159 


. . 


159 


Chester. 








Lunatics in Unions .... 273 








Not in Unions .... 23 








296 








Accommodation in County Asylum for 110 


296 


155 


141 


Cornwall. 








Lunatics in Unions .... 273 








Not in Unions 24 










297 


129 


168 


297 








Accommodation in County and Sub- "1 
scription Asylum at Bodmin .J 














Cumberland. 








Lunatics in County . . . .161 


161 


. . 


161 


Derby. 








Lunatics in Unions . . . .164 








Not in Unions . .... 52 








216 








Accommodation in Licensed House, 7 

Hill Lane, Derby, for . .} ^* 








216 


24 


192 


* Devon. 








Lunatics in Unions .... 508 








Not in Unions 103 








611 








Accommodation in House at P]}inp- "1 
ton, licensed for . . .J 














Workhouse at Stoke Damerel licensed "1 „,, 
for 100, but only room for . / *^" 














100 


611 


100 


511 



A County Asylum for Dcvonsliire has been erected, hut is not yet opened. 



239 



Pauper Lunatics and Accommodation, 
Public and Private. 


Numbers 

in 
County. 


Accommodation. 


Numbers 
for wliom 

there is. 


Numbers 

for whom 

there is 

not. 


Dorset. 

Lunatics in County .... 
Accommodation in County Asylum for 


227 
113 


227 


113 


114 


Durham. 

Lunatics in County .... 
Accommodation in Private Asylums at 

Wreckenton, licensed for 

West Aucliland, do. for 

Gateshead Fell, do. for 

Benshams, do. for . 

Dunston Lodge, do. for 


210 

45 

40 
82 
52 

78 








Essex. 

Lunatics in County .... 

Accommodation in Licensed House"! 

at Witham for . . . .J 


297 

325 

2 


210 
325 


297 
2 


323 


Gloucester. 

Lunatics in Unions .... 
Not in Unions . . ... 


398 
100 








Accommodation in County and Sub- "1 
scription Asylum for . . .J 
Private Asylum at Fairford, licensed for 
,, „ Stapleton, do. for . 


498 

190 

120 
5 










314 


498 


315 


103 


Hereford. 

Lunatics in County .... 
Accommodation in Private Asylums at 

Hereford, licensed for 

Whitchurch, do. for . 


147 

28 
20 










48 


147 


48 


99 


Hertford. 

Lunatics in County . 


214 


214 




214 


Huntingdon. 

^ Lunatics in County .... 


56 


56 




56 


Kent. 

Lunatics in Unions .... 
Not in Unions . . ... 


465 
13 








Accommodation in County Asylum for 
Private Asylum at West Mailing for . 


478 

300 

12 










312 


478 


312 


166 


Lancaster. 

Lunatics in Unions .... 
Not in Unions . .... 


979 
123 








Accommodation in County Asylum for 
In Liverpool Asylum in 1842 


1102 

593 

36 










G-29 


1102 


629 


473 1 



240 



! 

Pauper Lunatics and Accommodation, 


Numbers 


Accommodation. 


Numbers 
for whom 
there is. 


Numbers! 


Public and Private. 


in 
Comity. 


for whom' 

there is 

not. 


Leicester. 








Lunatics in County . . . . 244 








Accommodation in County and Sub- "1 , „ „ 
scription Asylum for . • • J 


244 


130 


114 


Lincoln. 








Lunatics in County .... 296 








Paupers in Lincoln Subscription Asy- 1 -o 
lum, in 1842 . . . . J '"^ 


296 


73 


223 


Middlesex. 








Lunatics in Unions . . . . 884 








Not ia Unions ..... 735 








1619 








Accommodation in County Asylum for 1000 








Private Asylums at Bethnal Green, 1 „-_ 
licensed for ... J 








At Hoxton, licensed for . . . 300 


1619 


1560 


59 


Monmouth. 








Lunatics in County .... 105 


105 


. , 


105 


Norfolk. 








Lunatics in Unions .... 401 








Not in Unions 69 








470 








Accommodation in County Asylum for 220 








Paupers in Bethel Hospital, in 1843 . 72 








In Bethel Infirmary or Poorhouse . 27 








319 


470 


319 


151 


Northampton. 








Lunatics in County . . . . 269 








Accommodation in Subscription Asy- "1 , oi 
lum at Northampton, in 1842 .J 


269 


181 


88 


Northumberland. 








Lunatics in County . . . .32] 








Accommodation in Private Asylum at "1 , „ 
Newcastle, licensed for . • J 


321 


58 


263 


Nottingham. 








Lunatics in County and County ofl „„, 
Town 1 ^01 








Paupers in County and Subscription 1 , , „ 
AsylumforCounty&Towninl842.J ' 


261 


125 


136 


Oxford. 








Lunatics in Unions . . . .172 








Not in Unions 20 








192 








Private Asylum at Hook Norton, "I ^, 
licensed for . , . • J ' 


192 


74 


118 


Rutland. 








Lunatics in County . . . .24 


24 




24 


Salop. 








Lunatics in Unions . . . . 244 








Not iTi Unions 47 








291 









241 



Pauper Lunatics and Accommodation, 
Public and Private. 



Salop — continued. 

Brought forward . , . . 291 
Accommodation in Private Asylum, "1 

at Kingsland, near Shrewsbury, 5- 80 
licensed for . . . .J 

At Morda, near Oswestry, in 1842 . 14 

An Asylum is in progress of erection 
in this County. 

Somerset. 

Lunatics in County .... 572 
Accommodation in Private Asylums,! ^p. 

at Bailbrook, near Bath, for . J 

At Fairwater House, near Taunton,"! „ 

licensed for . . . . J 



73 



Southampton. 

Lunatics in Unions .... 405 
Not in Unions . . . . .43 

448 
Accommodation in Private Asylums, at! 
Lainston, near Winchester, licensed J- 80 



for .... 

Nurstling, near Southampton,' 
Hilsea, Portsmouth, licensed i 
In Carisbrook, in 1843 



licensed for 
for . 






Stafford. 

Lunatics in Unions 
Not in Unions . 



62 

38 
27 

207 

384 
68 



452 
185 



Paupers in County and Subscription "1 
Asylum in 1842 . . . .J 

Private Asylum, Sandfield, near Licli- 1 nn 
field, licensed for . 



Suffolk. 

Lunatics in County .... 
Accommodation in County Asylum for 
Private Asylum, Belle Vue, near 
Ipswich, licensed for 

Surrey. 

Lunatics in Unions .... 
Not in Unions ..... 



215 

361 

180 

16 



521 

70 

591 



Accommodation in County Asylum for 360 
Private Asylum at Peckham, licensed for 210 



Sussex. 

Lunatics in County 



Numbers 

in 
County. 



291 



572 



448 



452 



361 



591 



251 251 



Accommodation. 



Numbers 
for whom 
there is 



94 



73 



207 



215 



196 



570 



Number! 

for whom 

there la 

not. 



197 



479 



241 



237 



165 



21 
251 



242 



Pauper Lunatics and Accommodation, 
Public and Private. 


Numbers 

in 
County. 


Accommodation. 


Numbers 
for whom 
tbere is. 


Numbers 

for whom 

there is 

not. 


Warwick. 

Lunatics in Unions .... 225 
Not in Unions , . , . . 181 








406 

Accommodation in Private Asylum at! -^ 
Duddeston, licensed for . . .J 


406 


60 


346 


Westmoreland. 

Lunatics in County .... 50 


50 




50 


Wilts. 

Lunatics in Unions .... 357 
Not in Unions ..... 25 








382 
Accommodation in Private Asylum at"! „c 

Laverstock,near Salisbury, licensed for J 
Fisherton, near Salisbury, for . . 90 
Devizes, licensed for . . . .180 
Market Lavington, licensed for . .135 
HindoD, licensed for . . . . 2 








442 
Worcester. 

Lunatics in County .... 284 
Accommodation in Private Asylum at "1 -^ 
Droitwich, licensed for . . J 
York, East Riding. 

Lunatics in Unions . . . .173 
Not in Unions 14 


382 

284 


442 
60 


224 


187 
Accommodation in Private Asylums at 

Nunkeeling, licensed for . . 2C 
Heple, near Hull, do. for . . 24 
Hull Retreat, do. for . . . 96 
Somercoats, near Hull, do. for , i 
Hunington, near York, do. for . 30 








173 
York, North Riding, 

Lunatics in Unions . . . .144 
Not in Unions ..... 2i: 


187 


173 


14 


167 

Accommodation in Private Asylum at 

Gate Helmsley, licensed for . 40 


167 


40 


127 


York, West Riding. 

Lunatics in Unions .... 664 
Not in Unions 363 








1027 
Accommodation in County Asylum for 420 
,, at Private Asylum"! ,- 
at Acomb, in 1842 . . . / 


' 






435 


1027 


435 


592 


AiNSTV, AND City of York, and Suburbs. 

Lunatics . . . . . 3S 
Private Asylum at Heworth, licensed for 13 


38 


13 


25 



243 



WALES. 


Panper Lunatics and Accommodation, 
Public and Private. 


Numbers 

in 
County. 


Accommodation. 


Numbers 
for whom 
there is. 


Numbers 

for whom 

there is 

not. 


Glsmorgan. 

Lunatics in 155 

Private Asylum at Briton Tarey, \ „/. 
licensed for J 

Pembroke. 

Lunatics in .... . 105 
County Asylum at Haverfordveest . 18 


155 
105 


36 
18 


119 

87 



Counties in England and Wales in which there are no 
Asylums of any kind, either Public or Private, and 
the number of Pauper Lunatics chargeable to 
Unions in each County, August, 1843 : — 



ENGLAND. 



Berkshire 

Buckinghamshire 

Cambridge 

Cumberland 

Essex . 

Hertford . 

Huntingdon . 

Monmouth • . 

Rutland 

Sussex 

Westmoreland 

Anglesey 

Brecon 

Cardigan 

Carmarthen . 

Carnarvon 

Denbigh 

Flint 

Merioneth 

Montgomery . 

Radnor 



WALES. 



PAUPER LUNATICS. 

. 260 


, 


. 147 


. 


143 


. 


, 173 


. 


354 


. 


225 


, 


65 




. 117 


. 


26 




. 278 


• 


57 


. . 65 




66 




119 




162 




149 




84 


, 


60 




83 


, , 


107 


. 


22 



APPENDIX E. 

DIETARIES OF PAUPER PATIENTS. 

Note,— The Weekly Charges for Pauper Patients will be found in the Lists of Asylums, 

Appendix A. 



COUNTY ASYLUMS. 
BEDFORDSHIRE. 



Males. 
Milk Porridge, with 8 oz. of Bread. 



bbeakfast. 

Females. 
Milk Porridge, with 7 oz. of Bread. 



Tea and Bread and Butter for a portion of the Patients, instead of 
Milk Porridge. 



DINNERS. 



Sunday, Tuesday, and Thursday. 
6 oz. Meat, with Vegetahles. 

Monday, Wednesday, and Friday. 

8 oz. Bread, with Soup, made from 

Meat hoUed the preceding day. 

Saturday. 
1 Ih. Suet Pudding. 



Sunday, Tuesday, and Thursday. 
5 oz. Meat, with Vegetables. 

Monday, Wednesday, and Friday. 
7 oz. Bread, with Soup. 

Saturday. 
f lb. Suet Pudding. 



SUPPEB. 



Bread, 8 oz.; cheese, 2 oz.; and 
half-a-pint of Beer. 



Bread, 7 oz.; cheese, 1^ oz.; and 
half-a-pint of Beer. 



Tea and Bread and Butter for a portion of the Patients, the same as 

Breakfast, each day, instead of Bread, Cheese, and Beer. 
Patients employed in the House and Garden have half-a-pint of Beer 

twice each day. 
Sunday afternoon, all the Female Patients have Tea and Currant Cake. 
Patients, who require it, have anything that is ordered by the Medical 

Superintendent. 



245 



CHESHIRE. 





Breakfast. 


Dinner. 


Supper. 


Monday . . 


Porridge, with Milk, 


Strong Meat Soup, with 


As Breakfast. 




1 quart ; for Men, 


Vegetables and Sea- 






2 oz. Bread in Por- 


soning, 1 quart ;, 






ridge. 


Bread, 6 oz. 




Tuesday . . 


Ditto. 


6 02. Beef or Mutton, 
or other Meat. 


Ditto. 


Friday . , . 


Ditto. 


6 oz. Bread, 


Ditto. 


Saturday . . 


Ditto. 


1 lb. Potatoes. 


Ditto. 


Wednesday • 


Ditto. 


Pudding, with Treacle 
for Sauce (much ap- 
proved.) 


Ditto. 


Thursday 


Ditto. 


1 quart of Soup, as 
above ; 6 oz. Bread ; 
1 lb. Potatoes. 


Ditto. 


Sunday . . 


Cocoa or Coffee, with 


1 quart Meat Sconce 


Ditto. 




Sugar, Milkj Bread 


or Irish Stew, sea- 






and Butter. 


soned with Onions 
and Pepper ; 3 or 4 
oz. Bread ; Bacon 
sometimes added, 
well chopped, to the 
Stew. 


; 



One horn of Beer allowed each Mau with his Dinner, daily. 



CORNWALL. 

Males. 
Breakfast . Sunday, \ 
Monday, 

Tuesday, ) Broth, 1 pint; Bread, 7 oz. 
Wednesday, 
Friday, J 

Thursday, J Milk, ^ pint; Wa,ter, ^ pint; 
Saturday, \ Oatmeal, 3 oz.; Bread, 6 oz. 

Dinner . . Sunday, ^ 

Monday, f Peas Soup, 1^ pint; Bacon, 2 oz.; Bread, 

Thursday, t 4 oz. 

Friday, ; 

Tuesday / Stew, 2 lbs.; Meat, 2 oz.; Suet Dump- 

'^' ( ling, 4 oz. 

S t -d I ^^"P' ^i P"^*' Vegetables; Bread, 6 oz. 

Supper , . . • . Oatmeal Porridge, 1^ pint; Bread, 4 oz. 



Breakfast 
Dinner . 



Sunday, 

Thursday, 

Monday, 

Tuesday, 

Thursday, 



246 

Females. 

Oatmeal Gruel, 1^ pint, containing Milk, 
I pint; Oatmeal, 1| oz. ; Cake, 5 oz. 



Supper 



J- Same as Males, 

Same as Males, with 3 oz. of Bread, 
i Same as Males. 

Sdf ^'^' } ^^"'^ ^' ^^^^'' ^'^^^' ^ ''"• 

Tea, with 5 oz. of Bread and Butter. 



Dinner 



DORSET. 
Sunday, "\ 

Monday, (Meat, 5 oz. cooked, free from bone, and 
Wednesday, t Vegetables. 
Thursday, ) 

Tuesday, . 1 pint of Soup ; Bread, 6 oz. 
Friday, . . Suet Puddmg, 1 lb. 

Q , i j Pie Crust, |^lb.; Potatoes; Meat, 3 oz.; 

oaturdav, s x> i • ^ i 'i 
•" ( Beer, i pmt daily. 



breakfast. 



Males. 



1 pint Milk Porridge, thickened 
with Oatmeal ; Bread, 6 oz. 



Females. 



1 pint Milk Porridge, thickened 
with Oatmeal; Bread, 5 oz. 



SUPPER. 



Bread, 6 oz. ; Cheese, 2 oz. ; 
Beer, J pint. 



Bread, 5 oz. ; Cheese, 2 oz. ; 
Beer, J pint. 



The Female Patients, who make themselves generally useful, have Tea 

and Butter, if preferred. 
The out-door Workers and Laundry Women have an extra quantity of 

Beer daUy. 



GLOUCESTER. 

Breakfast. . 1 lb. of Bread with Butter, and three parts of a Quart 
of Milk Gruel. 

1 part Milk. 

2 " Water. 

1 " Flour and Oatmeal. 



247 

Supper. . . ^Ib. Bread with about 1 oz. Cheese, and a Pint of Table 
Beer for the Men. 
Tea and Bread and Butter for Women (no limit). 
Dinner. . . 6 oz. of dressed meat (Beef or Mutton) on Tuesdays, 
Thursdays, and Sundays, with Potatoes and Bread, 
and one Pint of Table Beer. (Healthy Male 
Patients 8 oz.) 

Saturday. — Meat Pies and Irish Stew. 
Monday. — Broth with Bread, and Vegetables, 
6 oz. Bread, Potatoes in addition. No Beer. 

Friday. — Rice Pudding and a slice of Bread, 
No Beer. 



KENT. 





Breakfast. 


Dinner. 


Supper. 


Sunday . . 


Porridge of Oatmeal 
and Milk, with 6 
ounces of Bread, 
every morning, for 
all the Patients. 


For Men 6 oz. of Boiled 
or Roast Beef, free 
from bone; 4 oz. of 
Bread, and ^ Pint of 
Table Beer. —The 
Women have 4 oz. 
of Meat, &c. &c. 


For Men 2 oz. Cheese, 
and § Pint Beer 
every evening ; for 
Women Tea, with 
Bread and Butter in 
the proportion of 
1 oz. Tea and 3^ oz. 
Butter a week. 


Monday . . 


Ditto. 


Beef Pudding, Vege- 
tables, and Beer, as 
before. 


Ditto. 


Tuesday . . 


Ditto. 


Soup made from the 
bones of the preced- 
ing days, -with thin 
Beef added, thick- 
ened with Scotch 
Barley, Oatmeal, and 
Vegetables, and 6 oz. 
of Bread. 


Ditto. 


Wednesday . 


Ditto. 


Meat Pies or Pudding, 
as before. 


Ditto. 


Thursday . . 


Ditto. 


Rice or Suet Pud- 
ding; Men, 12 oz.. 
Women, 10 oz. ; 
Bread, 4 oz. 


Ditto. 


Friday . . . 


Ditto. 


Meat in quantities the 
same as on Sunday. 


Ditto. 


Saturday . . 


Ditto. 


Soup as on Monday, or 
Suet Pudding as be- 
fore. 


Ditto. 



A Pint of Beer and 2 oz. of Meat on Pudding Days. 



248 



LANCASTER. 

MEN. 





Breakfast. 


Dinner. 


Supper. 


Bread. 


Oatmeal 

and 
Flour. 


Mutton 
or Beef 
uncook- 
ed, with 
Bones. 


Bread. 


Flour. 


Bread. 


Oatmeal 

and 
Flour. 


Cheese. 




Sunday 
Monday 
Tuesday 
Wednesday. 
Thursday . 
Friday . . 
Saturday . 

Total 


5 oz. 
5 — 
5 — 

5 — 
5 — 
5 — 


3i 07.. 

H — 

r — 

3^ - 
3J - 

H - 


7 oz. 

7 — 

3| - 

7 — 
7 — 
7 — 
7 — 




4 oz. 
4 — 


7ioz. 
5 — 

7i - 

n - 

5 — 
7i - 
7i - 






Coffee. 

Porridge. 

Beer. 

Tea. 

Porridge. 

Beer. 

Tea. 


3^ oz. 


2 oz. 
2 — 


2 oz. 


31 - 











30 


28 


45| 


2 


8 


46i 


7 


4 




WOMEN. 




Breakfast. 


Dinner. 


Supper. 


Bread. 


Oatmeal 

and 

Flour. 


Mutton 
or Beef 
uncook- 
ed, with 
Bones. 


Bread. 


Flour. 


Bread. 




Sunday .... 
Monday .... 
Tuesday .... 
Wednesday . . . 
Thursday . . . 
Friday .... 
Saturday . . . 


5^ oz. 

H - 
H - 
H - 
H - 
H - 


2f oz. 
2f - 
2f _ 
2f - 
2f _ 
2f - 
4 — 


7 oz. 

7 — 
7 — 
7 — 
H - 

7 — 
7 — 






5^ oz. 

5i - 
5i - 
5i - 
Si - 
H - 

5i - 


with Tea. 
« Coffee. 
" Ditto. 
" Tea. 
« Coffee. 
" Ditto. 
" Ditto. 




1 oz. 


3^ oz. 
4 — 




To 


tal 


21 


20A 


4H 


1 


7i 


38i 





LEICESTERSHIRE. 

Breakfast . Sunday, Porridge of Oatmeal and Milk, with 4 oz, 

of Bread; the Males being allowed 1^ 
pint ; the Females 1 pint. 

Dinner . . . . Roast or BoUed Meat, 8 oz. for the Men, 

and 6 oz. for the Women, when cooked 
and free from bone ; Potatoes and other 
Vegetables ; I pint of Table Beer for 
the Men, | pint for the Women. 



249 

Tea .... Allowed the Females only. 6 oz. of Bread, 

and 1 oz. of Butter per day, with 1 oz. 
of Tea, and ^ pound Sugar per week. 

Supper . . . . Bread and Cheese and Table Beer; the 

Men being allowed 6 oz. of Bread, 1 oz. 
of Cheese, with 1 pint of Table Beer ; 
the Women 4 oz. of Bread, ^ oz. of 
Cheese, with ^ pint of Table Beer. 
Monday, Soup, made from the Liquor in which the 
Meat had been boiled the day previous, 
thickened with Peas and other Vegeta- 
bles ; 1^ pint for the Men, 1 pint the 
Women ; Bread and Cheese, 6 oz. of 
the former, and 1 oz. of the latter, for 
the Men; the Women being allowed 
4 oz. of Bread, | oz. of Cheese. Tea 
and Supper as before. 
Wednesday, Soup, as on Monday, with the same allow- 
ance of Bread and Cheese and Table 
Beer. Tea and Supper as before. 
Tuesday, Boiled Mutton, Men, 8 oz.. Women, 6 oz., 
with Vegetables; Men 1 pint. Women 
I pint of Table Beer. Tea and Supper 
as before. 

Thursday, Boiled Beef, in the same quantity as the 
Mutton on Tuesday, with Vegetables and 
Table Beer. Tea and Supper as before. 

Friday, Soup, as on Wednesday, with the same 
allowance of Bread and Cheese and Beer. 
Tea and Supper as usual. 

Satm-day, Meat Pies, or Suet or Rice Puddings, 1 lb. 
to the Men, | lb. to the Women, with 
Bread and Cheese and Table Beer. 
This Dietary is occasionally varied by the addition of Fruit Puddings in 

the season. 



Breakfast 
Dinner . 



Supper 



250 



MIDDLESEX. (Hanwell.) 



Males, 



Sunday, 

Tuesday, 

Wednesday, 

Friday, 

Monday, 

Thursday, 
Saturday, 



Milk, thickened with Oatmeal and Flour, 
1 pint ; Bread, 6 oz. 

^ Meat, 5 oz. cooked. 
(Yeast Dumpling, 4 oz, 
fBeer, ^ pint, 
) Vegetables, 

1 pint Soup; Bread, 6 oz.; Beer, ^ pint. 
j Irish Stew, 12 oz. ; Bread, 6 oz. ; 
( Beer, half-a-pint. 

f Meat Pie Crust, 12 oz. ; Meat, li oz. ; 
\ Beer, haLf-a-pint. 

Bread, 6 oz. ; Cheese, 2 oz, ; Beer, 
half-a-pint. 



EXTRAS TO WORKMEN. 

Out-door Workers to he allowed ^ pint of Beer at 11 o'clock, a.m. and 

at 4 P.M. daily, and 1 oz. of Tea and 4 ozs. of Sugar per week. 



Breakfast 
Dinner . 



Supper 



Females. 

. Bread, 5 oz. ; Butter, ^ oz.; Sugar, 4 oz. 
per week; Tea, 1 pint. 

Stmday, "^ Meat, 5 oz. cooked. 

Tuesday, (Yeast Dumpling, 4 oz. 

Wednesday, j Beer, half-a-pint. 

Friday, / Vegetables. 

^ , ( 1 pint Soup; Bread, 6 oz.; Beer, half- 

Ti,,,va^a^ / I^i^^ ^*®^' 12 oz.; Bread, 5 oz,; Beer, 
inm-saay, | half-a-pint, 

„ , / Meat Pie Crust, 12 oz. ; Meat, lA oz. ; 

baturaay, | ^^^^.^ half-a-pmt. 

. Milk, thickened with Oatmeal and Flour, 
1 prut ; Bread, 5 oz. 



EXTRAS TO LAUNDRY WOMEN, &c. 

Laundry Women to be allowed half-a-pint of Beer at 4 p. M., and toge- 
ther with Helpers, &;c., 1 oz. of Tea and 4 oz. of Sugar per week, 
in heu of the ordinary Supper. 



251 



Breakfast (daily) 

. Sunday, 



Dinner 



Monday, 
Tuesday, 



NORFOLK. 

Men. 



Supper (daily) 



Bread, 6 oz. ; Milk Broth, 1| pint, or 

1 oz. of Cheese and 1 pint of Beer. 

Beef or Mutton, 4 oz. cooked ; Bread, 

2 oz.; Potatoes, 1 lb.; and Beer, 1 pint. 

J Suet Pudding, 10 oz.; Potatoes, 10 oz.; 

\ Beer, 1 pint. 

j'Beef or Mutton, 4 oz. ; Bread, 2 oz. ; 

\ Potatoes, 1 lb.; Beer, 1 pint. 

Axr A /I /Suet Pudding, 10 oz.; Potatoes, 10 oz.; 
weanesaay, I Beer, 1 pint. 

rp, 1 TBeef or Mutton, 4 oz.; Bread, 2 oz. ; 

^' \ Potatoes, 1 lb.; Beer, 1 pint. 

Tji . 1 / Suet Pudding, 10 oz.; Potatoes, 10 oz.; 

^' \ Beer, 1 pint. 

Saturdays, . Ditto ditto ditto. 

Bread 6 oz. ; Meat Broth, ! 
Cheese, 1 oz. ; Beer, 1 pint 



pint, or 



Breakfast 


(daily) 


Dinner 


Sunday, 




Monday, 




Tuesday, 

Art/ AflTK^GnOI 




VV cU.llt/&U.cl' 

Thursday, 


Supper . 


Friday, 
Saturday, 
, Sunday, 



Women. 

Milk Broth, 1^ pint, or Tea, half-a-pint, or 
Beer, half-a-pint; Bread, 5 oz., in lieu 
of Broth (if preferred) ; 1 oz. Cheese 
or ^ oz. Butter. 

Beef or Mutton, 4 oz. cooked ; Bread, 
2 oz.; Potatoes, 1 lb.; Beer, half-a-pint. 

(Suet Pudding, 10 oz.; Potatoes, 10 oz.; 
Butter, ^ oz, 
(Beef or Mutton, 4 oz.; Bread, 2 oz.; 
Potatoes, 1 lb.; Beer, half-a-pint. 
Wednesday, / Suet Pudding, 10 oz.; Potatoes, 10 oz.; 

{Beef or Mutton, 4 oz.; Bread, 2 oz.; 
Potatoes, 1 lb. ; Beer, half-a-pint. 
{Suet Pudding, 10 oz.; Potatoes, 10 oz.; 
Butter, ^ oz. 
Ditto ditto ditto 

Meat Broth, IJ pint; and Bread, 5 oz.; 
or Cheese, 1 oz.; and Beer, half-a-pint, 
or Tea, half-a-pint ; and Butter, 1 oz. 

(Bread, 5 oz.; Cheese, 1 oz.; or Butter, 
I oz.; and Beer, half-a-pint. 



Monday, 



252 



Tuesday, 

Wednesday, 

Thursday, 

Friday, 

Saturday, 



The same as on Sunday. 
The same as on Monday. 
The same as on Sunday. 
The same as on Monday. 
Ditto ditto. 



NOTTINGHAM. 

MALES. 











Meat. 


•13 


i 

o 








1 








^ 

e- 


a 






i^ 


^ 






C3 


u 


2 




s 


% 


a 


a 




« 


■3 


g< 


R 




K 


n 


Hi 


f^ 


Ib.oz. 


Pint. 


O 
Ib.oz. 


Pint. 


(1( 

lb. oz. 


Ib.oz. 


Dms. 





Ib.oz. 


lb. oz. 


Ib.oz. 


Ib.oz. 


Ib.oz 


Sunday .... 


10 


6 


13|0 10 


4 jO 1 




3 




. , 


i 






Monday .... 


. . 


. . 


1 10 10 


U 






3 




3 


i 


1 




Tuesday .... 


10 


6 




10 








3 




. . 


« 1 






Wednesday 




. . 




10 


n 






3 




3 


i 


+ 




Thursday 


10 


6 




10 


, . 






3 




. . 


« i 






Friday .... 


. . 


, . 




10 


u 






3 




3 


i 


f 

3 

Oil 




Saturday 


4 


.4 




10 
6 8 


1 

94 


1 


7 


3 

1 5 


7 


9 


i 
If 




lbs. . 


2 2 


1 6 


7 3 


FEMALES. 




Meat. 


1 
1 




3 


i 


1 




1 
o 


i 


C3 


"3 


U 


.1 

a 
o 


i 


1 


1 


3 


02 


"3 




Ib.oz. 


Ib.oz. 


lb.( 


■)7,. 


lb. oz. 


lb. oz. 


Ib.oz. 


Pint 


Ib.oz. 


Pint. 


Ib.oz.' 


Ib.oz. 


Dms. 




Ib.oz. 


Ib.oz.; 


Ib.oz. 


Sunday 


9 


5 





11 


12 


3 


$ 


7 


1 


f 


. . 


i 


. , 




,V 


^0 A 


Monday 


. . 


. . 


1 





8 


1 




7 


1 


f 


20 1 


« 




tV 


io 1 


Tuesday 


9 


5 





15 


12 


, , 




7 


1 


i 


•• } 






tV 


10 ^ 


Wednesday 


. . 


. , 


1 





8 


1 




7 


1 


f 


20 ^ 


+ 




tV 


1 


A 


Thursday . 


9 


5 





15 


12 


, . 




7 


1 


f 


.. 1 






Vr 


* 


i 


Friday . . 


. , 


. , 


1 





8 


1 




7 


1 


« 1 

1 


20 i 


I 

3 




Tc 


i 


A 


Saturday . 


4 


4 





15 


2 


1 




7 


1 


.. 1 


1 
3 




0^ 


^ 


4 










— 


























lbs. . 


1 15 


1 3 


6 


8 


6 12 


7 


t 


49 


7 


5 i 


60 If 


1* 


. . 


or^ 


Si 


34 



STAFFORD. 

Males. 

Breakfast . . . Milk Porridge, 1 pint ; Bread, 8 oz. 

Dinner . Sunday, Meat, 8 oz. cooked; Bread, 6 oz. ; Beer, 

1 pint ; Vegetables. 
Meat Pie, 1 lb. ; Vegetables ; Beer, 1 pint. 

(Suet Pudding, 10 oz.; Soup, 1 pint; 
Bread, 6 oz.; Beer, 1 pint. 
Wednesday, The same as Sunday. 



Sunday, 

Monday, 
Tuesday, 



25i 



Breakfast 
Dinner 



Thursday, 

Friday, 
Saturday, 



Supper 



rRice Pudding, 8 oz.; Bread, G oz.; 
\ Beer, 1 pint; Soup, 1 pint. 
The same as Sunday. 
The same as Thursday. 
. Bread, 8 oz.; Cheese, 2 oz.; Beer, 1 pint. 

Females. 
Tea, 1 pint, with Sugar and Milk ; Bread, 

6 oz.; Butter, | oz. 
Meat, 6 oz. cooked; Bread, 6 oz. ; Beer, 

I pint ; Vegetahles. 
Meat Pie, 12 oz. ; Beer, f pint. ; Vegeta- 
hles. 

, r Suet Pudding, 8 oz, ; Soup, 1 pint ; 

Tuesday, | ^read, 6 oz.; Beer, f pint. 
Wednesday, The same as Simday. 
mi , TRice Pudding, 6 oz.; Bread, 6 oz.; 

Ihursday, | Beer, f pint ; Vegetahles. 
Friday, The same as Sunday. 

Saturday, The same as Thursday. 
The same as Breakfast. 



Sunday, 
Monday, 





SUFFOLK. 




Day. 


Breakfast. 


Dinner. 


Supper. 


Sunday . . 


Milk Gruel, and 6 oz. 
of Bread each, Oat- 
meal 12 lbs. and 6 
galls, of Milk for 
about 200 Patients. 


Males, 8 oz. Bread, 
1^ oz. Cheese, and 
pint of Beer. Fe- 
males, same, except 
1 oz. less Bread. 


Males, i lb. Bread, f 
oz. Butter, and ^ 
pint Tea. Females, 
same, except 1 oz. 
less Bread. 


MoKDAY . . 


Ditto. 


Males, 6 oz. Meat, 4 
oz. Bread, f pint 
Beer ; and Vegeta- 
bles. Females, same, 
with 1 oz. less Meat. 


Males, i lb. of Bread, 
1^ oz. Cheese, and 
f pint Beer. Fe- 
males, same, with 1 
oz. less Bread. 


Tuesday . . 


Ditto. 


Soup from Monday, 
with additional Meat, 
and 6 oz. Bread each. 


Same as Sunday. 


Wednesday . 


Ditto. 


Males, Suet Dumpling 
of 1 lb. and Females, 
one of f lb. with f 
pint Beer each. 


Same as Monday. 


Thursday . . 


Ditto. 


Same as Monday. 


Same as Wednesday. 


Friday . . 


Ditto. 


Same as Tuesday, 


Same as Tuesday. 


Saturday • 


Ditto. 


Same as Wednesday, 


Same as Thursday. 



254 



SURREY. 



Day. 


Breakfast. 


Dinner. 


Supper. 


Monday . . 


1 pint of Milk Por- 
ridge, with 6 oz. of 
Bread for Males, and 
4 oz. for Females. 


Soup thickened with 
harley, peas and 
Vegetables, with 6 
oz. of Bread. 


1 pint of Milk Por- 
ridge, with 6 oz. of 
Bread, for Males,and 
4 oz. for Females. 


Tuesday . . 


Ditto. 


Boiled Beef, 6 oz. free 
from bone, with 4 oz. 
of Bread, f of a pint 
of Beer, and Vegeta^ 
bles. 


Ditto. 


Wednesday . 


Ditto. 


Baked or boiled suet 
pudding, 16 oz. for 
Males, and 12 oz.for 
Females, with ^ of a 
pint of Beer. 


Ditto. 


Thursday 


Ditto. 


Meat pie with Vegeta- 
bles, and f of a pint 
of Beer. 


Ditto. 


Friday . . 


Ditto. 


Baked Rice pudding 
with Treacle. 


Ditto. 


Saturday . . 


Ditto. 


Boiled Mutton, &c. as 
on Tuesday. 


Ditto. 


Sunday . . 


Ditto. 


Boiled or roast Mut- 
ton, or Beef, as on 
Tuesday. 


Ditto. 



The Male Patients who work in the garden and farm, as well as those employed as 
bricklayers, carpenters, painters, plumbers and glaziers, and in the engine-house, are 
allowed for luncheon, bread and cheese, with three quarters of a pint of beer for each ; 
and the Females employed in the kitchen and laundry, bread and cheese, with half-a- 
pint of beer each ; and the whole of the Female Patients in employment, whether in the 
kitchen, laundry, or wards, receive two ounces of tea, eight ounces of sugar, and eight 
ounces of butter. 

The sick throughout the establishment are dieted at the discretion of the Medical 
Officers. 



Breakfast 
AND Supper 

Dinner 



YORKSHIRE WEST RIDING. 

Milk, 1 gallon ; Water, 2 gallons ; Oatmeal, 2| lbs. ; 
Wheat Flotu-, I lb.; of which each Patient is 
allowed 1| pint. 

Yeast Dumphngs, with Treacle Sauce, and Boiled 
Beef or Mutton, with Vegetables, on Sundays, Tues- 
days, and Thursdays ; 6 oz. of Meat, free from 
bone, allowed for each Patient. Mondays, Wed- 
nesdays, and Fridays, Soup made from the Meat 



255 

boiled the day before; each Patient allowed H pint. 
Saturdays, Rice Currie; 2 oz. Rice, 2 oz. Meat, 
with Vegetables, for each Patient; each Patient is 
allowed | pint of Beer to Dinner. 



St. PETER'S HOSPITAL, BRISTOL. 

Dinner . . Meat, 4 oz. dressed, without bone, four times a-week; 
Peas Soup twice, and BoUed Rice once, with haK-a- 
pint of fresh Table Beer each day. 

Breakfast . A pint of Milk Porridge (one part Milk and two of 
thick Oatmeal Porridge) with Bread ; some of the 
Patients have Tea, which is supphed by their friends. 

Supper . . Bread and Cheese ; 2 oz. of Cheese and a sufficiency 
of Bread: there is generally some left. The Pa- 
tients are under medical treatment, &c., and have, 
once or twice a week. Roast Meat. The Vegetables 
are generally Potatoes ; sometimes Green Vegetables 
in the Pea Soup. 



Breakfast, 

DAILY 



Supper 



Dinner 



PEMBROKE, HAVERFORDWEST. 

Milk and Oatmeal Porridge, 2 pints, of which half is 
Milk — no Sugar. The Men have Bread in addi- 
tion, and the- Women Bread and Butter, about 

8 oz. each. 

1| pint of Broth, in which Meat has been boiled, and 

9 oz. of Bread. The Women are allowed also 
\\ oz. of Butter every day, and the Men 3 oz. of 
Cheese three times a week each (in addition to the 
Broth). 

Sunday, Wednesday, and Friday, Meat (generally 
fresh), about 5 oz., and li lb. of Potatoes. 

Monday, Beef's Head, stewed, 2 pints, (Meat and 
Soup together,) and 1| lb. of Potatoes. 



256 

Tuesday, Two salt Herrings for each, and \\ lb. of 

Potatoes. 
Thursday, 2\ pints of Rice Milk; 4 lbs. of Rice al- 
. lowed for 19 persons, no Bread nor Potatoes. 
No Beer is allowed the Patients at any time. — The drink is Water. 



PUBLIC SUBSCRIPTION ASYLUMS. 

LINCOLN. 





MALES. 




Breakfast. 


Dinner. 


Supper. 


Bread, 6 oz. 


Bread, 3 oz. 


Bread, 6 oz. 


New milk, boiled, 


Meat, cooked and 


New milk, boiled, half- 


1 pint. 


boned, 4 oz. 
Vegetables, 10 oz. 


pint. 


FEMALES. 




Bread, toasted, 5 oz. 


Bread, 3 oz. 


Bread, toasted and 


Tea, 1 pint. 


Meat, cooked and 


buttered, 5 oz. 




boned, 4 oz. 


Tea, 1 pint. 




Potatoes, 10 oz. 


• 


Sunday . . Roast Beef. 




ThWay .^''*^} Boiled Mutton: 




Tuesday and\ 
Friday . . ./ 


Boiled Beef. 





Wednesday and \BoLled Beef; or cold meat warmed with Soup, 
Saturday . .) 1 pint, for half the patients. 

An Ox cheek is stewed with the soup weekly. 

No Beer is allowed. 

Carrots are used occasionally instead of potatoes. . 



257 



NORTHAMPTON. 



Solids per Week: — 





Males. 


Femalei 




oz. 


oz. 


Bread, not less than 


. 102 


102 


Solid Meat, cooked, about . 


. . 18 


16 


Cheese, &c., not less than 


. 10 


8 


Meat pudding, ditto . 


. . 16 


14 


Potatoes, about . . . 


. 72 


72 


Total 


. . 218 


212 


Fluids per Week : — 






Milk gruel, about . . « . 


. 168 


112 


Soup, "... 


. . 72 


72 


Beer (three bushels to the hogshead), 


about 112 


5Q 


Tea 


. — 


5Q 


Total 


. . 352 


296 


Extra Diet : — 






Breakfast, boiled milk 


. 16 


8—12 


Dinner, meat every day 


. . 5 


5 


Supper " ... 


. 5 


5 


Bread, instead of vegetables 


. . 6 


6 


Lunch, bread and cheese 


. 5 


5 


Beer (at 11 a.m. and 4 p.m.) 


. . 8 


8 


Sick diet regulated by the necessities of the indivic 


uals. 



YORK. 
There is no regular Diet Table. The Pauper Patients have meat five 
times a week for dinner, with bread, potatoes, and other vegetables. For 
Breakfast the men have milk and oatmeal ; the women, tea. For Supper 
they have bread and cheese, with a pint of beer. 



258 



METROPOLITAN LICENSED HOUSES. 

1. 
PECKHAM HOUSE. 

DIETARY FOR ^PAUPERS. 

Breakfast. 



Oatmeal Porridge . 
Bread . 



rMeat 
Sunday, I 
Tuesday, ■{ Potatoes 
Thursday, I Bread 

^Beer 

Monday, ^ o 
Wednesday, Vg^eL 
Friday, J ^^^^aa . 



Saturday Irish Stew 
Bread 



Made chiefly with Milk. No limit to quantity. 
Do. do. 

Dinner. 

160 lbs., or once a fortnight Mutton 

180 lbs. for 245 Patients. 
No limit to quantity. 
Do. do. 

1 Pint. 

No limit to quantity. 
Do. do. 

The Soup is made from the liquor in which 
the Meat for the whole Establishment 
(Private Patients, Paupers, and Servants) 
is boiled the previous day, together with 
all the bones, with the addition of Barley, 
Pease and green Vegetables. 

No limit to quantity. 
Do. do. 

The Stew is made with 60 lbs. Meat, for 
250 Patients, with Potatoes, Onions, &c. 



Supper. 

Bread . . No limit to quantity. 
Cheese or Molasses Do. 

Beer . . One pint. 



Breakfast 



EXTRAS TO WORKING PATIENTS. 
. Tea and Bread and Butter 



-p r Out-door Males . Bread and Cheese, and 1 pint Beer.. 

a orenoon, <(^ ^ash-house Females, Do. Do. | pint Porter. 

Afternoon, . . . Same as Forenoon. 

Supper, Females . Tea, and Bread and Butter, 



259 



Breakfast 



Dinner 



Supper 



HOXTON HOUSE. 

. Gruel with Bread. The Patients who are 
generally industrious, and those who are 
sick, are allowed Tea. 

. Meat, (1 lb., including Bone^) and Vege- 
tables, varied according to season^ four 
days per week. Fresh Mackerel and Her- 
rings when in season. Soup three times 
per week, made with Meat, Peas, and 
Vegetables. Suet, or Rice Puddings, or 
Fruit Puddings, when in season, substi- 
tuted for Soup occasionally. 

. Broth, with Bread, four times a-week. 
Bread and Butter, or Bread and Cheese, 
three times. 
Bread, 18 ounces per day allowed to each 

Patient. 
Beer given with the Meat Dinners, and with 
the Bread and Cheese, or Bread and 
Butter Suppers. 



BETHNAL HOUSE, BETHNAL GREEN, 



Sunday 


BREAKFAST. 


DINNER. 


SUPPER. 


1 Pint Gruel, 


8 oz. Meat, uncooked, Vegetables and Bread, 


Cheese, 2 oz. 




5 oz. Bread. 


of each ,5 oz. 


Bread, 5 oz. 


Monday 


do. 


Rice and Milk. 5 oz. Bread. 


do. 


Tuesday . 


do. 


8 oz. Meat, uncooked, Vegetables and Bread, 
each 5 oz. 


do 


Wednesday 


do. 


Pudding, 15 oz. 


do. 


Thursday . 


do. 


8oz. Meat, uncooked. Vegetables and Bread, 
each 5 oz. 


do. 


Friday . . 


do. 


Pudding, 15 oz. 


do. 


Saturday . 


do. 


8 oz. Meat, uncooked, Vegetables and Bread, 
each 5 oz. 


do. 



Females, as above, 2 Pints of Table Beer per diem for Males, and one for Females. 
All Patients occupied in hard labour have Meat daily, and also an allowance of Porter, 
varying from half-a-pint to two pints a day. 

Sick Diet comprehends Fish, Eggs, Rice, and light Puddings, with the addition of Ale, 
Wine, and Brandy, or anything else that the Medical Officer may deem necessary. 

S 2 



260 



PAUPER DIETARIES IN THE FOLLOWING PROVINCIAL 
LICENSED HOUSES. 



County. 


Proprietor. 


Asylum. 


No. 


Devon 


Langworthy, R. C . 


Plympton House, Plymouth . 


1 


Durham . . . 


Glenton, Messrs. . 


Bensham, Gateshead . . 


2 




Kent, S. . . . 


Gateshead Fell 


3 




Wilkinson, J. E. . 


Dunston Lodge, Whickham . 


4 


Gloucester . . . 


lies, A. . . . 


Fairford .... 


5 


Hants 


Twyman, J. . . , 


Lainston House, Winchester . 


6 


Hereford . . . 


GiUiland, J. . 


Hereford . . . . 


7 


Northumberland 


Smith&Mackintosh,Mes''s- 


Newcastle on Tyne 


8 


Oxford . 


Mallam, Richard . 


Hook Norton . . . . 


9 


Salop . . . . 


Jacob, James . 


Kingsland, Shrewsbury . 


10 


Somerset . 


Terry, St. . 


Bailbrook House, Bath . . 


11 


Warwick . . , 


Lewis, Messrs. 


Duddeston Hall, near Birm. . 


12 


Wilts . ... 


Finch, W. . . . 


Layerstock House, Salisbury . 


13 


Ditto 


Finch, W. C. . 


Fisherton House 


14 


Ditto .... 


Langworthy, C. C. 


Kingdown House, Box . 


15 


Ditto 


Phillips, T, . 


Belle- Vue House, Devizes 


16 


Ditto .... 


Willett, R. 


Fiddington House 


17 


Worcestershire . 


Ricketts&Hastings,Mesrs 


Droitwich . . - . 


18 


York, North Riding . 


Martin, James 


Gate Helmsley 


19 


,, East Riding 


Casson, Richard 


Hull 


20 



The weekly charges for Pauper Patients will be found in the list of Asylums in 
Appendix A. 



PLYMPTON HOUSE, NEAR PLYMOUTH. 

DIETARY. 

Breakfast . . . Bread only (without Butter), and Milk 

and Water. 
The elderly Patients, however, and those 
who are not very strong, have Bread and 
Butter with their Milk and W^ater. 

Supper . : . Same as Breakfast. 

Dinner . Monday, ^ 

Thursday f Boiled Rice, with Salt; Bread and Po- 

and C tatoes. 
Saturday, ) 
Tuesday, Pease Soup, with Vegetables and Bread. 



261 



"Wednesday, Potatoe Pie, 

/"Soup made of Beef, with Vegetables, 
< Potatoes, and Bread — the Meat is cut 
(^ up, and given with the Soup. 

(Boiled Beef and Vegetables, and Bread, 
no limit. 
Milk and Water is given for drink, if 
asked for. 



Friday, 
Sunday 



BENSHAM, NEAR GATESHEAD. 

Breakfast . . . Boiled Oatmeal and Milk. 

The Old and Invalid are allowed Tea. 

Dinner . Sunday and \ Boiled or Roast Beef, or Mutton, with 
Wednesday, J Potatoes and Bread. 

Thurtdl ^""^jCol^ M^^^^' ^''<^*^' ^^'^ Vegetables. 

T^ef^y^'^n Irish Stew 
Friday, I 

Saturday, Fish, or Fruit Puddings 

Supper • • Boiled Milk, Oatmeal, and Bread; some- 

times Cheese. 
The Patients are not limited to a prescribed 
quantity, which is regulated according to 
circumstances. 



GATESHEAD FELL. 
Every Morning . Breakfast, Hasty Pudding and Milk. 



Sunday 

Monday 

Tuesday . 
Wednesday 



Dinner, 
Supper, 
Dinner, 
Supper, 



Dinner, 
Supper, 



Beef and Mutton with Potatoes and Broth, 

Rice Milk and Bread. 

Barley Milk and Bread, 

Boiled Milk with Oatmeal and Bread. 

Same as Sunday, 

{Fish when it can be procured, or Flour 
Puddings with Treacle Sauce. 

Same as Monday. 



262 



Thursday- 
Friday 
Saturday . 



Same as Sunday. 

Same as Monday, or Mince and Bread, 

Ox Head and Hough Soup, with Potatoes 
and Bread. Boiled Milk and Bread for 
supper. 

All the Working Patients have Meat Din- 
ners daily. Old people with the work- 
ing Females have Coffee or Tea. 

During illness the Diet is ordered by the 
Medical attendant. 



DUNSTON LODGE, near 
GATESHEAD. 

MEN PAUPERS. DIET TABLE. 



Breakfast 


Milk and Hasty Pudding. 


Supper . 


Milk Gruel with Bread. 


Dinner . Monday, 


Soup with Meat in it. 


Tuesday, 


Meat Stew or Suet Dumplings. 


Wednesday 


, Soup with Meat in it. 


Thursday, 


Meat Pies or Meat Stew. 


Friday, 


/Boiled Barley and Milk, Working Men, 
\ Meat. 


Saturday, 


Soup with Meat in it. 


Sunday, 


Fish, or Meat Pie, or Boiled Beef. 




WOMEN PAUPERS. 




Supper. 


Breakfast 


Coffee, Tea. 


Dinners 


. Same as the Men, or nearly so. Their 




Diet is varied as much as possible, and 




not stinted in quantity. 



263 



Breakfast 



Supper 



Dinner 



FAIRFORD GLOUCESTEESHIRE. 

Such of the Patients as labour have Ale and 
Table Beer mixed, and, occasionally, 
Meat for their Breakfast ; and are, more- 
over, allov^ed small quantities of Tobacco 
and Snuff. 
DIETARY. 
. Bread and Butter (in the Winter sometimes 
Toast and Lard), with Tea and Milk and 
Water ; a large round of Bread. 

. (Women) Bread and Butter and Tea 
(Men) Bread and Cheese ; a large round 
of Bread, with 2i oz. of Cheese, and 
Table Beer ; some have a pint and some 
half-a-pint. 

. Meat, generally, every day in the Summer, 
with Suet Puddings and Vegetables, 
(Potatoes, Cabbage, Peas, or Beans). 
The Meat consists of Beef, Mutton, 
Bacon, and Pork, and weighs, when 
dressed, about 6 or 7 oz. If Bacon 
alone, 5 oz. only. 
In the Winter, there is always one day 
(sometimes, but rarely, two) on which 
the Patients have Pease Soup instead of 
Meat. On other days, the Dinner con- 
sists of one quart of Soup, having the 
stewed Meat in it, and Bread — Table 
Beer — some have one pint, and some 
half-a-pint, as they wish it, at Dinner. 
The Patients who work have Table-Beer 
and Ale mixed. 



September, 1842. 



264 



6. 
LAINSTON HOUSE, WINCHESTER. 

DIETARY. 

Sunday . Baked Meat, Pudding, and Vegetables. 

Monday . Boiled Meat and Vegetables, with Bread. 

Tuesday . Baked or Boiled Suet Puddings. 

Wednesday Boiled Meat and Vegetables. 

Thursday . Ditto Ditto Ditto. 

Friday . Ditto Ditto Ditto. 

Saturday . Soup with Vegetables, and Bread, 

A pint of Table Beer to each Man, daily, and 
I of a pint to each Woman, daily. For 
Breakfast, the Female Paupers have 
Coffee, with Milk, and Bread and Butter, 
In the Evenings, Tea and Bread and 
Butter. The Pauper Men, for Breakfast 
obtain Milk PoFridge or Broth ; in the 
Evening, Bread and Cheese, and Beer. 

The Diet is the same for the two sexes, 
excepting at Breakfast as above specified. 

In regard to Epileptic cases, the attendants 
are directed to cut less. 



7. 
HEREFORD LUNATIC ASYLUM. 

DIETARY. 

Breakfast . . One quart of milk (skimmed) with bread, 

or sometimes in the winter, when milk 
is scarce, some of the Male Patients 
have 1 quart of broth with bread in it. 
A few of the women have occasionally 
Tea or Coffee, with bread* 



265 



Supper 



Dinner 



Bread and Cheese, about 8 or 9^ oz. of 
Bread with about 3 oz. of Cheese, (it is 
not weighedj) with 1 Pint of Beer. A 
few of the women, if invalids or in deli- 
cate health, have Tea instead of Beer. 

Two days Rice Pudding — a large plateful 
not weighed. 

Two days Soup and Bread, 1 quart of 
Soup with a large piece of Bread. 

Three days Meat and Potatoes. It is made 
into an Irish Stew, not weighed, no 
Bread. 



8. ^ 

NEWCASTLE -ON-TYNE LUNATIC ASYLUM. 

DIETARY. 
Breakfast . . Milk Gruel, ad lib., with Bread for Break- 
fast and Supper. 
Dinner . . . 8 oz. of solid Meat with Potatoes, on Sun- 
days, Tuesdays, and Thursdays. 

Broth, with a proportion of Meat cut up in 
it, ad lib., with Bread, on Mondays, 
Wednesdays, and Saturdays. 

Rice and Milk, ad lib., with Bread, on 
Thursday. 

The Working Patients are allowed Beer 
and have solid Meat daily, with Tea 
morning and evening. 

Patients advanced in years have also Tea 
morning and evening. 

The Sick have Diet suitable to their respec- 
tive Cases, and Fasting Patients, and 
those labouring under peculiar delusions, 
have anything they can be persuaded to 
take 



266 



9. 
HOOK NORTO^r, OXFORDSHIRE. 

DIETARY. 

Breakfast . . Bread and Milk, or Broth, or Bread and 

Butter and Coffee. 

Dinner . Sunday, Boiled Mutton, with Bread and Yegetahles. 

Monday, Suet Pudding. 

Tuesday, Bacon, with Bread and Vegetables. 

„, , J TRice Pudding, with a slice of Bread and 
Wednesday, | g^^^^ ^^^ ^^^^ ^^^ 

{Boiled Beef or Mutton, with Bread and 
Vegetables. 

Soup with Bread. 

{Rice Pudding, with a slice of Bread and 
Bacon for the Men. 

One pint of Beer is allowed to eaoh Male, 
and half a pint to the Females for Dinner, 
excepting Soup day. 
Supper . . . Bread and Cheese and Beer for the Men. 

Bread and Butter and Tea for the Women. 

Those who work are allowed Bread and 
Cheese and Beer extra. 



Thursday, 

Friday, 
Saturday, 



Sunday, 
Monday, 
Wednesday. 
and Friday. 

Tuesday, 



Thursday 

and 
Saturday. 



10. 
KINGSLAND, NEAR SHREWSBURY. 

DIETARY. 
^ Breakfast . Half a pound of Bread and Milkmeal. 
' Dinner . Six ounces of Meat and Potatoes. 
hSupper . Half a pound of Bread and Broth (no 
' J ^"^ limit). 

Breakfast . Half a pound of Bread and Milkmeal. 
Dinner . Pease Soup (no limit.) 
Supper Half a pound of Bread and Milkmeal. 

-i Breakfast . Half a pound of Bread and Broth 
VDinner . Eleven ounces of Suet Puddmg and Broth, 
/supper . Half a pouiid of Bread and Milkmeal. 

The Men who work have Beer; the 
Women who work have Tea and Sugar. 



267 

11. 

BAILBROOK HOUSE, BATH EASTON. 

DIETARY. 

Breakfast .... H pint of Milk, Gruel, or Tea or Coffee, and 

5 ounces of Bread as they like, (if Tea or 
Coffee, Butter also). 

Supper, (Men) 5| ounces of Bread, and 1 ounce of 

Cheese, 1 pint of Table Beer. 
(Women) have Tea or Coffee, or half-a-pint 
of Beer, and 5| ounces of Bread, and 1 
ounce of Cheese. 
Dinner ..... On Wednesday, Friday, and Sunday, 6 

ounces of dressed Meat without bone, and 
Yegetables at discretion ; no Bread; 1 pint 
of Beer, Men — half-a-pint. Women. ' 
On Thursday and Saturday, Baked Rice 
pudding, I pound before boiled, coarse 
Sugar or Treacle, IJ pint of Broth with 
Bread in it, no Beer. 
On Monday, 1 1 pint of Broth with Bread 

in it, and vegetables besides, no Beer. 
On Tuesday, Suet Pudding, | of a pound, 
Vegetables at discretion; and Beer (one 
pint for the Men, half-a-pint for the 
- Women). 

Patients employed at out of door or in door 
labour, have Meat every day, and an extra 
meal of Bread and Cheese and Beer, at 
eleven o'clock, a.m. 



268 



12 
DUDDESTON HALL, BIRMINGHAM. 

DIETARY, 
Bbeakfast . . Milk Thickened. 

Dinner . . .3 days a week, meat and abundance of vege- 
tables. 
2 days a week, broth. 
I day Pease Soup 
Bread and Cheese once a week. 
About half a pound of Bread is allowed at 
each meal. 
Supper . . . Bread and Cheese on Soup and Broth 

days ; and on Meat days Milk thickened. 
Those who work have an extra meal of 
Bread and Cheese, and also Tobacco once 
a week. 



13. 
LAVERSTOCK HOUSE, NEAR SALISBURY. 

DIETARY. 
Breakfast .... One pint of Skimmed Milk, and about 

half-a-pound of Bread. 
Occasionally, a pint of Broth and Bread. 

Tea One pint of Tea with Bread and Butter, or 

half-a-pound of Bread, with 3 ounces of 
Cheese, and 1 pint of Table Beer. 

Dinner . Wednesday ( ^^°"" *-*° ^ ^^ ^ P^^"*^ ^^ ^°* ^"^* ^'*^^ 



Friday and 
Sunday. 



Bread, (i pound) and vegetables, 1 pint 
of Table Beer, (on Sundays, Suet Pud- 
ding in addition). 

Monday 
Thursday 
and , 
Saturday. 

Tuesday | pound of Bread, and 3 ounces of Cheese^ 

and 1 pint of Table Beer. 

Sometimes (in the winter) pease soup, 1| 

pint, with as much Bread as they like. 



Cold Meat (or cheese), with Bread and 
Vegetables, Potatoes and Cabbage, 1 pint 
of Table Beer. 



269 



14. 

FISHERTON HOUSE, FISHERTON AUGER, WILTS 

DIETARY. 

Breakfast (In Summer.) For the Men, 6 to 8 ounces 

' of Bread, and 2J ounces of Cheese, one 

pint of Table Beer. 

(The Bread varies from 6 to 8 ounces, and 
depends on the Patient's appetite, and on 
the work he performs.) 

(In "Winter.) One pint of Broth, made with 
Bones, groats and vegetables, &c., and 
from 6 to 8 ounces of Bread ; no Beer. 

The Women have one pint of Cocoa, with 
6 ounces of Bread, and 2 ounces of 
Cheese. 

Supper Same quantity of Bread and Cheese and 

Beer as at Breakfast, for the Men. 

One pint of Cocoa, with 6 oxmces of Bread 
and 2 ounces of Cheese, for the Women. 

Dinner Four ounces of Meat every day, together 

with as much Vegetables as they like. 
They generally have three sorts of Vege- 
tables all the year round, that is to say. 
Potatoes, Greens, and Carrots, (or Pars- 
nips). They are not allowed any Bread 
with their Dinner. Each Patient has one 
pint of Table Beer. 

The Patients who work are allowed an 
extra meal, every day, of Bread and 
Cheese, and small quantities of Snuff or 
Tobacco are occasionally given to them. 



270 



15. 
KINGSDOWN HOUSE, BOX. 

DIETARY. 
Breakfast . . . One quart of Gruel, (Milk and Oatmeal), 

one-third Milk, and a round of Bread. 
Supper . i. Cocoa and Milk and a quart of Broth, with 

a round of Bread for the Men. 
The Men who work have for eupper Bread 
and Cheese and Beer. 
Dinner . . . Meat and Vegetables, five times a week, 

consisting of Beef, or Bacon, or Mutton, 
with Potatoes or Cabbage. — Each Patient 
has about 6 oz. of Meat; half-a-pint 
of Beer is allowed for Dinner on the meat 
days. 
On Friday there is boiled Rice with Treacle, 

and some Milk in addition. 
On Tuesday, a quart of Soup with Bread or 
Potatoes ; water only allowed for Dinner 
on the Soup and Rice days. 
The Men who are at work have Meat, 
Vegetables, and Beer, always for dinner. 



Breakfast 



Supper 



Dinner 



16. 
BELLE VUE HOUSE, DEVIZES. 

DIETARY. 

. A quart of Milk Porridge (more than one- 
third Milk), with Bread cut into slices. 

. Bread and Butter, or Bread and Cheese (as 
much as they like), with Table Beer — - 
more than half-a-pint — or Tea. 

. Four days in the week, Meat ; about 4 or 5 
oz. of Mutton, Beef, or Bacon, with 
Potatoes, Cabbage, or other Vegetables, 
with half-a-pint of Table Beer — no Bread. 



271 

The Beef is sometimes salt and sometimes 
fresh. Two days Suet Pudding (no limit), 
with half-a-pint of Table Beer. The other 
day Bread and Cheese for Dinner (no 
limit), and rather more than half-a-pint 
of Table Beer. 
In the winter the Patients have Pease Soup 
once a week, instead of the Pudding ; 
about a quart, with Bread in it. 



17. 

FIDDINGTON HOUSE, WILTS. 

DIETARY. 
Breakfast . .1 quart of Broth with Bread in it, or 1 quart 

of Milk with Bread in it. 
Nearly 90 of the Parish Patients are 
allowed Tea. 
Dinner . . . Meat, five days a week, consisting of about 

6 oz. of Beef, Mutton, or Bacon, with 
Potatoes, Greens, or other Vegetables; 
no Bread ; one pint of Table Beer. 
1 quart of Pease Soup with Bread in it, or 
On Monday, -^ the same quantity of Broth thickened with 

Rice ; 1 pint of Beer. 
--V n , , r Bread and Cheese, 8 oz. Bread and 3 oz. 
\ Cheese ; 1 pint of Table Beer. 
Such of the Patients as work have Ale and 
Bread and Cheese at eleven and four 
o'clock, making five meals a day ; and for 
supper, a pint of Ale extra. 



'•( 



272 



Breakfast 



Dinner Sunday, 

Monday, 
Thursday, 
s and 

Saturday, 

Tuesday, 



Supper 



18. 
DROITWICH. 

DIETARY. 

Bread and Milk ; Men a quart, "Women a 
pint (containing 8 oz. of Bread for the 
Men, and 6 oz, for the Women). 

8 oz. of boiled Mutton, 1 pound of Pota- 
toes, and Beer. 

-Soup, a quart, with 8 ozi of Bread. 



1 lb. of Suet Pudding for the Men, and 
three-quarters of a pound for the 
Women, with Beer. 

Wednesday "^Eight ounces of boiled Beef, and 1 lb. of 

•p, . T j Potatoes, with Beer. 

- - - Bread and Cheese and Beer, 8 oz. of 
Bread and 1 oz. of Cheese. 
If ill, the Patient's Diet is regulated by 
the Medical Officer. 



19. 
GATE HELMSLEY, NEAR YORK. 

Breakfast - - Milk and Oatmeal, 1| pint, with Bread 

without limit, — Patients who are old, or 
in delicate health, are allowed Tea. 

Stjpper - - - The same. 

DtNN'ER _ - - Five days Meat (twice boiled, and three 

times roasted), the roasted Meat is not 
weighed, but something short of Jib. is 
given to each Patient, — No Bread is 
allowed with the Meat (except to old or 
Invalid Patients), but Suet Pudding is 



273 

given, and a variety of Vegetables, with 
the Boiled Meat, (which is less in quantity 
than the Roasted Meat.) — Soup is served, 
and Pudding, filling altogether a pint- 
and-a-half vessel. 
Two days (Monday and Thursday) there 
are Meat Pies, with Potatoes in them : a 
large plateful is given, but not weighed. 
— No Beer is allowed, except to Invalids 
and to Patients who work. 



20. 
HULL AND EAST RIDING REFUGE, HULL. 

Breakfast Men 1 pint of Oatmeal and Milk, and 8 oz. of 

Bread. 
Women 1 pint of Tea and 8 oz. of Bread. 
Dinner Men and Women : — 

Sunday, 8 oz. Meat, 14 oz. Potatoes, 1 pint Small 

Beer. 
Monday, I pint of Soup, 8 oz. Bread. 
Tuesday, Ox-head Broth, with Greens, and Barley 

and Peas; or, 
1 pint of Meat Hash, with Potatoes and 

Herbs, and 8 oz. Bread. 
Wednesday, Fish, and 14 oz. Potatoes ; or, Pease-Soup 

with Bread, and 1 pint of Beer. 
Thursday, 8 oz. of Meat, with 14 oz. of Potatoes, 

and 1 pint of Beer. 
Friday, 1 pint of good Meat and Vegetable Broth, 

with 8 oz. of Bread. 
Saturday, 1 pint of Rice Frumety, and half-a-pint of 

Beer. 



274 



APPENDIX G. 



SCHEDULE 1. 

Statement of Criminal Lunatics, April, 1843. 





In County 
Asylums. 


In Licensed 
Houses, j 


In other 

Public 

Asylums. 


Total. 


M. 


F. 


Tot. 


M. 


F. 


Tot. 


M. 


F. 


Tot. 


M. 


F. 


Tot. 


•j-Beds 


9 




9 


1 




1 








s 




"^ 


Chester 


10 


1 


11 














10 


1 


11 


Cornwall .... 


6 


2 


8 


. , 












6 


2 


8 


Devon 








6 




6 








6 




6 




9 




2 


5 


i 


6 








2 

5 


i 


2 


^Durham 






Gloucester . . . . 


6 


3 


9 


1 




1 








6 


4 


10 


fHants 








2 




2 








2 


. . 


2 


' Kent 


5 


2 


7 


, , 




. . 








5 


2 


7 


Lancaster .... 


15 


2 


17 














15 


2 


17 


Leicester .... 


4 




4 






. . 








4 




4 


Norfolk 


1 




1 














1 




1 


*Nor\vich . . . . 






, 






, , 








2 


, . 


2 


Notts 


3 


1 


4 






. . 








3 


1 


4 


fOxon 


1 




1 


1 




1 








2 


. , 


2 


fSalop 








3 




o 








3 




3 


+Somerset . . . . 








1 




3 








1 


2 


3 


Stafford 


2 




2 














2 


2 


2 


Suffolk 


4 


1 


5 


1 




i 








5 


1 


6 


•fSussex 






, , 


1 




1 








1 




1 


fWarwick .... 






. . 


1 


i 


2 








1 


i 


2 


fWilts 








5 


3 


8 








5 


3 


8 


fWorcester . . . . 








3 




3 








3 




3 


York, West Riding . 


2 


i 


3 






. . 








2 


1 


3 


fDo. East Riding . . 






. , 


i 




1 








1 




1 


Bethlem Hospital . . 














64 


21 




64 


2]' 


85 


Metropolitan District . 








15 


7 


22 








15 


7 


22 


Gaols 








Totals . . . . 


63 


13 


76 


47 


14 


61 


66 


21 


87 


205 


52 


257 



* Infirmary Bethel, a detached Lunatic Ward of the Union Workhouse. 
In the Counties distinguished by a f tlicro arc no County Asylums. 



APPENDIX F. 



NUMBER OF PAUPER LUNATICS AND IDIOTS CHARGEABLE IN EACH UNION IN ENGLAND AND WALES IN THE MONTH OP AUGUST 1843. 





ABSTRACT of RETURNS 


,.ho. 


ng the 


Number of PArPER Ldsatics and I 


niOTS chargeable to Parishes compriaed in each Usios in England and Wales, in the Month of Au"ust 1843 














each Sex, whether Daogero 


lis to themselves or others, where maintained, and the Average Weekly Cost per Head for Maintenance 


Clolhing, A'c. 






























Nombor o 


f LunaliM and Idiots chaigeablo to Piiriihei la each Union, id tho MoDth of August 1843. 






























1 l| 


ERE MAI-NtAlNED. 


WHEKE MilKlAlNED. 




AGES. 












Averag* WMkly Cort 


™-™'- 


Z. 


•■ 




~B, 




imoT, 




"and" 


" 


















se 


i 

i 


MnlDleMnco^dClotbtng. 




o.. 


UceQHil^naaie. 


Onion WorkhouM. 


WllhthBlr Friend*. 


I 


I 


,0 


M 


1 


! 


10 


I 




LiKS 


10 


„ 


Iti 


\i 


1 


r 








































M. 


■'• 


TolU. 


M. 


'• 


Tow. 




"- 


''• 


Tol.1. 


M. 


''• 


'^°"' 


"■ 


*"• 


'"'"■ 


M. 


''- 


Tolnl, 







— 












wart.. 


" 












ENGLAND; 
































































,. d. 






jj 




37 


30 


73 


34 


30 


64 


137 


MO 














20 


35 


55 


10 


19 


29 






fi 


32 












20 
76 


24 


71 




D"",o.t.« ■ ■ 


190,307 
U0J52 


50 


73 


129 
79 


02 
32 


69 
36 


131 


147 


1-10 




5 


10 


24 




46 


17 


20 


43 


27 
20 


53 
26 


80 
40 






20 


60 
23 


42 


58 






8 


44 


9 OJ 


S t] 


2 6} 






29 














































29 
















8 w\ 


910! 




















































23 


04 
















4 9) 


7 0* 


2 4 


1 4 








102 


160 


95 


74 




























87 






n 


40 




















3 6J 






49 


33 


82 




49 


































11 


47 
















8 OJ 

ri 








30 


34 


04 


5? 


































































94 


123 






164 






















































?? 


■> ni 


4 3 






49 


78 


127 




























































5 






02 


64 


126 


75 


63 
























































' 4 








96 


148 




111 


206 




















































V'A 


7 in 






S3I),.M2 


93 


112 


205 


86 


101 


187 


392 


MO 






142 






24 






115 


52 


69 


111 








77 


90 


79 


61 










i ii 










29 




67 


























































■s?* 










m'.m 










68 




































IK 




























17 


19 






17 


































































119 


176 


295 


94 


133 


227 


522 


MO 






225 


18 




54 






143 


35 


65 


100 




2 










92 


51 








8 1 












311 


340 




























































6 0' 






4 ?! 






58 


67 


































































4 71 






69 


77 


166 
































































5 7 


MiDOLMM 




301 


441 


742 


108 


120 


228 


970 


MO 


191 


260 




97 




245 






241 


10 


17 


33 






44 








165 






















20 


33 


59 


























































8 91 












88 


119 


207 




121 


































































51 


74 




























































9 8 












04 


70 






103 






































64 





























57 


78 


135 


5S 




123 


258 


110 




62 














109 


26 


23 


49 






13 


50 










5 




50 


" u 




2 114 


4 111 




ui,;iso 


42 


48 














3 




























19 


38 




37 




14 


II 


34 




9 


8 9) 


■i n 










5 






7 






































2 
















11 71 













45 






71 


84 




240 


110 




8 
















43 












62 
















10 7 ilO 9i 


2 61 


4 41 


So»nin. . 


311,413 


76 
102 


135 
158 


260 


150 
97 


95 


192 


452 


110 
MO 




'i 


'3 


84 


115 


199 




'77 


I35 


113 
55 










38 








92 


60 


23 


135 


140 


7 4 


b"! 


2 64 
2 lOj 


5 4f 




442,348 


65 


86 


171 










































90 




















2 5 


4 H 




3U,722 


99 




219 






167 


































m 


75 
















5 in 




2 41 






(12,580 


147 




363 








537 
































n 


















8 m 




3 3( 


7 0( 




223,485 






105 , 










































60 
















10 3 


9 9 


2 lOJ 


5 11 


w",Z"u«.' ■ ■ 


220.029 
56,469 


10 




29 


10 




'?8 


57 


110 




10 


. '.^ 




8 


14 




IS 


24 


7 




19 






" 


40 


59 
8 


17 


29 


29 


14 


61 


57 


'0 0* 


8 U 


2 BJ 
2 SJ 


4 111 






95 


113 








165 




2-10 




8 


12 


86 










73 


54 




114 






in 
















67 


8 7 










386,108 




81 




70 






307 


9-100 




10 


31 


35 






47 




99 






98 






n 


58 


66 














8 Oj 




■2 10 


5 3J 




180,218 


47 












183 






15 


33 


















43 






10 


38 




42 










48 








5 64 




180,527 


33 


44 


77 


37 


38 


75 


152 


8100 
























































ToT«u or ENGLAND 


790,751 


158 


160 


318 


152 


192 


344 


662 


8-100 


131 








' 






116 






101 


178 


■5 


S 


sm" 


130 
2,050 


151 


141 


123 


48 


21 


247 


I37 


6 OJ 


9 9 


2 5} 


3 1li 


18,152,341 


3,060 


3,873 


0.933 


3,188 


3.494 


6,082 


13,015 


110 


1,650 


1,839 


3,489 


1,039 


1,218 


2,267 


1,773 


2,200 


3,973 


1,75 


2,138 


3.696 


2.904 


2,95 


2,956 


2.174 


581 


3.359 


2,421 


7 6J 


8 11J 


2 7i 


4 lU 


WALES : 










































































Anolkut 


38,105 


10 


20 


30 


17 


IS 


35 


05 


2-10 




















27 


38 


65 






2 


12 


16 


5 


12 


13 


5 


3 


10 








2 41 


2 4t 




55,399 





IS 


21 


20 


25 


45 


66 


1-10 






















34 






2 




13 




11 




9 


2 
















75,136 


17 


24 


41 


29 


49 


78 


119 


2-10 


1 




















71 


116 






7 


19 


27 






16 


5 




1.5 






2 a) 






110,404 


20 


35 


01 




57 


101 


102 


1-10 






















80 


142 






12 


24 






n 


18 


6 
















86,728 




10 


42 


42 




107 


149 


210 
























146 








20 


26 


34 


■24 


30 


6 
















08,483 







14 


36 


34 


70 


84 


MO 






5 














34 


36 


■70 






6 


24 


17 


18 


12 




2 


12 




II 9i 










04,355 






11 


23 


20 


49 




9-100 




















18 




44 








16 




12 


9 






9 


13 


11 -a 










178,041 


28 


47 


75 


34 








9-100 








13 












45 










9 


29 


29 


31 


28 






18 


28 












50,696 


7 


10 


17 




26 












1 














48 


27 75 










16 


13 








7 


31 


10 












11 


10 




36 


50 








3 






2 












39 




90 
















20 






27 


10 










78.563 


12 




27 


34 




78 










15 














29 


43 












17 


22 


15 


13 
















T«iii.. ot WALES 


19.554 


■■> 


3 





11 


5 


10 


22 


110 








- • 






• 






13 


8 


21 




- 


1i 


229 


233 




194 


1 
158 




-^ 


221 


9 7 


a iij 


2 5 


2 101 


884,173 


157 


209 


300 


300 


445 


811 


1,177 


1-10 1; 20 


10 


36 


20 ' 21 


41 


40 


50 


90 


446 


504 


1.010 


Totiuof59I Unliiiii' 


14,030,514 


3,217 


4,082 


7,299 


3,554 


3,939 


7,483 


14,792 


1-10 


1,070 


1,855 


3,525 


1,059 


1,239 


2,298 


1,813 


2,250 


4,063 


2.204 


2,702 


4,906 


5 


52 


991 


2,879 


3,197 


3,188 


2,368 


1,566 


631; 


3,466 


2,642 


7 7 


8 Hi 




4 9 


001 in VdIoi. . 

Eillmatca Tormforl 
I'.»oi.«i.iin.lW.io; 


1,870.315 


429 


544 


973 


474 


526 


999 


1,972 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


15,906.829 


3.046 


4,626 


8,272 


4.028 


4,404 


8.492 


10,764 


_ 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


,- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


- 


^ 


- 



275 



SCHEDULE 2. 

Cases of Atrocious Offences in County Asylums and Licensed 
Houses, April, 1843. 







In 




In Li- 






County 




censed 


Beds. . . 


CRIME. 


Asylums. 


CRIME. 


Houses. 


M. 


P. 


M. 


F. 


Murder 


9. 


Cuttingwithintent » 
to do bodily harm J 


1 
















Chester . 


Murder 

Arson 


I 
2 










Cornwall 


Smothering two "I 
Children . ./ 




1 


. 


•• 




Devon . 
Durham . 








Murder ..... 


1 


1 






Maliciously st:xbbing 


1 




Gloucester 


Murder 

Maliciously cutting 




1 
1 








Hants . . 




. . 




Murder 


1 




Kent . . 


Murder 

Infanticide .... 
Attempting to 1 
stab her husband J 


1 


I 
I 










• • 


. 


• • 




Lancaster 


Killing his wife . 
Killing his child . 
Other Homicides . 
Arson 


3 
1 
3 

1 




. 






Leicester 


Murder of his wife 
Arson 


1 
1 










Notts. . 


Burning stacks . . 


1 


1 








Siilop . . 








Arson 

Detestable crime . 


1 
1 




Suffolk . 


Murder 

Manslaughter . . 


1 

1 


1 








Sussex . 




, . 




Maliciously cutiing 


1 




Warwick 








Murder 




1 


Wilts . . 


• 










2 


Maliciously shooting 


1 


YorkW. "1 
Riding J 


Infanticide .... 




1 


. 


. . 


. . 


YorkE. 1 
Riding/ 




















Murder 


i 






c • 






Murder 

Infanticide .... 
Shooting his wife . 


1 
1 


2 
2 


Metrop. 
District 


' 






Killing his grand- 1 
father .... J 

Shooting with in- 1 
tent to kill . J 


1 

1 






















Attempt to drown 


1 






V ■ 






Cutting & maiming 


1 





INDEX. 



Accidents occasioned by disuse of restraint, 147, 148, 149, 151. 

Adelaide Fund for relief of Pauper Patients discharged from H;in\vcll , 
27. 

Admission of patients into Asylums, 163 — 168 ; law relating to, dis- 
regarded as respects Paupers, and evaded as respects Private 
Patients, 167. 

Allen, Dr., irregularities practised in his House, High Beach, Essex, 
36. 

Artesian Well, at Han well, 16. 

Attendants in Lunatic Asylums should be secured from danger, 150 ; 
additional risk to, incurred by diminution of restraint, 151. 

Bailbrook House, near Bath, formerly a private mansion, 42 ; im- 
provements in, 45 ; steps taken by Commissioners for amendment 
of, 67 ; deficient accommodation for exercise at, 135. 

Basement stories, use offer patients should be avoided, 22. 

Bath, Workhouse at, not licensed, but receives Lunatics, 10, 98. 

Bedford Asylum, a County Asylum established under 48 Geo. III. 
c. 96, and 9 Geo. IV. c. 40, 9 ; number of Patients at, 16 ; 
disadvantages of its situation, ib. ; sleeping cells in, 22 ; irregu- 
larity in management of, 25 ; possesses no resident Medical 
Officer, 28 ; enlarged twice, 84 ; number of Idiots in, 97 ; 
religious observances at, 162, 163. 

Belle Grove House, near Newcastle, badly conducted, 40. 

Belle Vue House, Devizes, improvements in, 45. 

Bensham, near Newcastle, a well-conducted Licensed House receiving 
Paupers, 41 ; improvements in, 45. 

Bethel Hospital, Norwich, included in class of Public Hospitals, 10 
an unlicenced Workhouse, i6. ; to a certain extent an exception 
from general rule of Public Hospitals as to patients defraying 
their own expenses, 32 ; site of, 33. 

Bethlem Hospital ; excepted from operation of 5 & 6 Vic. c. 87, 2 ; 
not included in enumeration of Lunatic Asylums, 10; number 
of Patients in, 186 ; Criminal Lunatics in, 196. 

V 



278 

BethDal Green, Asylums at, DonnitorieB in, 13 ; practice at, on discharge 
of Pauper Patients, 27 ; situated in Metropolitan district, 43 ; 
use of opiates at, 121 ; occupation of Patients at, 131 ; restraint 
at, 145 ; accident at, from want of restraint, 149. 
Birmingham, Workhouse at, not licensed, but receives lunatics, 10, 98; 
want of accommodation for exercise of Insane Patients at, 136. 
Bites, by Insane Persons, dangerous effects of, 147, 148. 
Bodmin, Asylum, want of water at, 16; defective ventilation, 17' 
use of galleries as day rooms, 22 ; yards, 23 ; religious observ- 
ances, 162. 
Books, use of, in Asylums, 130. 
Box, Asylum at, see Kingsdown House. 

Bristol, St. Peter's Hospital at, established under special Act, but 
included in class of County Asylums, 9 ; bad situation of, 15; 
deficient accommodation at, 52, 133 ; totally unfit for an Asylum 
for the Insane, 53 ; proposed enlargement of present premises 
inexpedient, 65. 
Briton Ferry, letter of Welsh parish oflScer to proprietor of Asylum at, 

200. 
Capper, Mr., Lis evidence as to Criminal Lunatics, 198. 
Carisbrooke, House of Industry at, included in class of Licensed Asy- 
lums, 10 ; improvements in, 43, 45. 
Cells, single sleeping, system of as compared with dormitories, 12, 13 ; 

general observations on, 21 ; usual size of, 22. 
Chaplains, should be appointed to every Asylum, 160 ; in Public Hos- 
pitals and County Asylums, 161, 163. 
Chester Asylum, a County Asylum established under 48 Geo. III. c. 
96 ; and 9 Geo. IV. c. 40, 9 ; mode of warming, 18 ; irregu- 
larity in management of, 26, 45 ; in a crowded state, 83 ; 
number of Idiots in, 97; practice as to restraint at, 144; reli- 
gious observances at, 161 ; Criminal Lunatic in, 197. 
Chevalier, Rev. Dr., irregularities practised in his house at Aspall 
Hall, Suffolk, 35 ; persisted in notwithstanding Commissioners* 
remonstrances, 38. 
Classification of Lunatics, 121 ; beneficial effect of, 122 et seq. ; at 
Lancaster, 126 ; at Gloucester, 127; enjoined in Metropolitan 
District, 147. 
Congenital Idiocy, defined, 108. 
Congenital Imbecility, defined, 108. 

Cornwall Asylum, united County and Subscription Asylum, esta- 
blished under 48 Geo. III. c. 96, and 9 Geo. IV. c. 40, 9, 30 ; 
expense at, for Paupers, 31 ; in a crowded state, 83 ; enlarged, 
84 ; number of Idiots in, 97 ; Chaplain appointed to, 161. 
Cornwall, county of, number of Lunatics in Workhouses and other 

places out of County Asylum, 83. 
Corporate and Borough towns not authorised to unite with counties in 

erection of Asylums, 11, note. 
County Asylums : — Regulated by 9 Geo. IV. c. 40, 1 ; several Asy- 
lums not erected for County purposes, brought within the Act> 



279 

2 ; list of those established under 48 Geo. Ill, c. 96, & 9 Geo. 
IV. c. 40, 9 ; Asylums established under special Acts included in 
class of, ib. ; provisions of Acts establishiag, 10 ; contracts for 
purchase of land for, 11; for North Riding of Yorkshire pro- 
jected, 11, note; comparative Cost of, 12; use of separate cells 
in, ib. ; comfort and advantage of dormitories in, ib., 13 ; 
Surrey Asylum, the last erected, 20 ; limitation of size, 23, 24 ; 
extent of accommodation afforded by those already erected, ib. ; 
formation of rules for, left entirely to Magistrates, 26 ; general 
rules for, desirable, ib. ; Resident Medical Officers at, 28, 114; 
general remarks on, 29 ; enlargement of, 84 ; insufBcient from 
increasing number of incurable cases, 85 ; main object of, cure 
of insanity, 88 ; filled with lucurable Lunatics, 87 — 97 ; admis- 
sion of Patients into, 93, 165 ; practice in, as to restraint, 143, 
144 ; religious observances at, 161 — 163 ; Chaplains at, 161 ; 
Reports of, 178, 179, and note. 

County Asylums united with Subscription Asylums, erected under 
provisions of 48 Geo. III. c. 96, & 9 Geo. IV. c. 40, 9, 30 ; 
advantages afforded by, to Pauper Lunatics not equal to those of 
County Asylums, ib. ; comparative expense, 31 ; merits of, ib. 

County Pauper Lunatics whose Settlements are not ascertained, 91 ; 
not included in Returns of Pauper Lunatics, 181. 

Craubourne Asylum, irregularities practised at, 39. 

Criminal Lunatics, objection to sending them to Asylums, 195 ; 
enactments respecting, ib. ; number of, 196 ; nature of their 
crimes, ib. ; risk of escape, 197 ; practice respecting at Home 
Office, 198 ; case of those becoming sane after committal, ib.; 
opinion of Lord Chancellor of Ireland respecting custody of, 
199 ; separate care and custody of, highly desirable, ib. 

Dancing, use of in Asylums, 139. 

Delirium tremens, described, 113. 

Dementia, defined, 105. 

Denbigh, Asylum about to be erected there, 200, note ; letter from 
Medical Practitioner there, 201, note. 

Denham Park, non-restraint System practised in Asylum at,"'145. 

Derby, Asylum at, formerly a private mansion, 42 ; gross abuses at, 
56 ; steps taken by Commissioners for amendment of, 66. 

Devizes Asylum, uses of Dormitories in, 13 ; a well conducted 
Licensed House receiving Paupers, 41. 

Devon Asylum — Plan of, objected to, 29, note. 

Devonport, Workhouse at, included in class of Licensed Asylums, 10 ; 
deficient in accommodation for exercise, 135. 

Diet, sufficient and appropriate, essential in treatment of Lunatics, 
118 ; want of, an exciting cause of insanity, 119. 

Dirty Patients, separate departments for, in Asylums, necessary, 124 ; 
means adopted for their cure, 147. 

Dormitoiies, comfort and advantage of, 12, 13; general observations 
on, 21. 

u 2 



280 

Dorset Asylum, a County Asylum established under 48 Geo. III. c. 
96, & 9 Geo. IV. c. 40, 9 ; inconveniently situated, 15 ; yards 
at, 23 ; in a crowded state, 83 ; number of idiots in, 97 ; effect 
of improvement of diet on Patients in, 118 ; occupation of 
Patients at, 131 ; case of necessary restraint at, 148 ; Chaplain 
appointed to, 161 ; religious observances at, 162. 

Dorset, County of, number of Pauper Lunatics belonging to, in Work- 
houses and other places out of County Asylum, 84 ; 

Droitwich, Asylum at, a well conducted Licensed House receiving 
Paupers, 41. 

Drunkenness, a frequent cause of Insanity, 115; difficulty of deter- 
mining on liberation of Patients apparently recovered from 
Insanity induced by, 175. 

Dryness, importance of in Lunatic Asylums, 16 ; illustrated by case of 
Dorset Asylum, 17. 

Duddeston, near Birmingham, Asylum at, formerly a private mansion, 
42 ; connection of with Workhouses, ib. ; steps taken by Com- 
missioners for amendment of, 66 ; Pauper Patients debarred from 
sufficient exercise at, 135. 

Dunnington, near York, Asylum at, of inferior description, 43 ; escapes 
from, 73. 

Dunston Lodge, near Newcastle, a well-conducted Licensed House, 
receiving Paupers, 41 ; irregularities at, 45 ; improvements in, ib. 

Dysentery, prevalent at Dorset Asylum, removed by re-laying the 
floors, formerly damp, 17. 

England and Wales, Acts relating to Lunatic Asylums in, 1, 2. ; 
divided into districts by Commissioners, 4. 

Epilepsy, various forms of, described, 110 — 112 ; proportional number 
of patients affected by, 112. 

Escapes from Licensed Houses, 72, et seq. ; penalty on Officers, &c. 
of County Asylums permitting, ib.; of Criminal Lunatics, 197. 

Exercise, importance of, in the open air, 129 ; yards and grounds 
for, should be provided, 130. 

Exeter Asylum, included in class of Public Hospitals, 10 : not fire- 
proof, 14 ; sum received at, for Private Patients, in 1842, 32 ; 
site of, 33 ; restraint at, 144. 

Fairford Asylum, use of dormitories in, 13 ; well conducted, 41 ; 
improvements in, 45 ; non-restraint system practised at, 145. 

Finch, Dr., irregularities practised in his House, Laverstock, Wilts, 39. 

Fisherton, near Salisbury, Asylum at, 42, 

Fish Ponds, Asylum at, case of beneficial Restraint in, 149. 

Fort Clarence, Military Hospital at, 31. 

Galleries used as dormitories, 12 ; warmth and ventilation of, \7 et 
seq. ; in St. Luke's Hospital, not warmed, and cold in winter, 20;; 
and so at Lincoln, 21 ; use of, as day-rooms, 22 23. 

Games, use of, in Asylums, 130. 

Gate Helmsley, near York, Asylum at, 43 ; religious observances 
at, 161. 



281 

Gateshead Fell, Asylum at, 43 ; improvement iu, 45 ; case of escape 
from, 72, 111, note," 198 ; religious observances at, 161. 

Gloucester Asylum, United County and Subscription Asylum establish e d 
under 48 Geo. III. c. 96, and 9 Geo. IV. c. 40, 9 ; fire at, 14, note 
yards at, good, 15, note; mode ofwarming and ventilating, 19,20 
arrangement of sleeping-cells in, 21 ; fund for relief of Paupo 
Patients discharged from, 27; expense of, for Paupers, 31 ; en- 
larged, 84 ; occupation of Patients at, 131 ; non-restraint system 
practised at, 140 ; practice as to admission of Patients into, 166. 

Great Foster House, near Egham, case of beneficial Restraint at, 
148. 

Great Wigston, neglect of magistrates in visiting, 68. 

Guy's Hospital, Lunatic "Ward in, included in class of Public Hos- 
pitals, 10 ; practice at, an exception from general rule of Public 
Hospitals, as to patients defraying their own expenses, 32. 

Halstock, Dorset, defective accommodation at Asylum there, 40. 

Hanwell Asylum, a County Asylum, established under 48 Geo. III. 
c. 96, and Geo. I'V. c. 40, 9 ; fire at, 14, note ; disadvantages of 
its situation, 15 ; grounds at, spacious, ib. note ; want of water at, 
16; defective ventilation at, 17, 20, 22 ; basement stories used 
for Patients, 22 ; use of galleries as day rooms, 22 ; yards at, 
23, 152; disadvantages of its extreme magnitude, 24 ; proposed 
extension of, 25 ; attendants at, ib. ; difficulty of maintaining 
order in, ib. ; fund for relief of Pauper Patients discharged from, 
27; appointment of Governor at, 28; escapes from, 74; in a 
crowded state, 83 ; establishment and subsequent enlargement 
of, 86 ; rule for admission into, 87; nearly filled with incurable 
Lunatics, 88, 89 ; cost of, 89; table of length of Patients' con- 
finement at, 94 ; cost of Patients in, ib. ; eflrect of improve- 
ment of diet in, 118 ; non-restraint system practised at, 140 ; 
use of solitary confinement at, 147; means adopted for cure of 
dirty habits at, 148 ; religious observances at, 163. 

Haslar, Naval Hospital at, 31 ; non-restraint system practised at, 140. 

Haverfordwest, Asylum at, established under special Act, but included 
in Class of County Asylums, 9 ; formerly a gaol, 15 ; possesses 
no resident Medical Officer, 28; detail of abuses there, 4.6 et seq. ; 
case respecting, laid before Law Officers of the Crown, 51 ; their 
opinion, ib. ; wholly unfit for treatment and cure of the 
Insane, 52 ; no provision for occupation, amusement, or exercise 
of Patients made at, 134 ; number of Patients in, 186. 

Hilsea, connection of Asylum at, with "Workhouses, 42 ; steps taken 
by Commissioners for amendment of, 66 ; deficient accommoda- 
tions for exercise, and want of employment at, 133. 

Hook Norton, Asylum at, 42. 

Hoxton, Asylum at, 44; deficient in accommodation for exercise, 134; 
use of restraint at, 145. 

Hull, Workhouse at, established under special Act, but iucluded in 
class of County Asylums, 9. 

Idiocy congenita], defined, 108. 



282 

Idiots— returns of numbers by Poor Law Commissioners, 96, 181 ; 
mistaken use of the term, ib.; numbers of, in Asylums, 97; often 
dangerous, ib. ; large proportion of, in Workhouses, ib. et seq. 

Imbecility Congenital, defined, 108. 

Insanity, principal forms of, 102 ; causes of, in Paupers, 115, 119; 
statistics of, 177 et seq. 

Insanity, moral, see Moral Insanity. 

Jones, Griffith, a neglected Welsh Pauper Lunatic, case of, 202. 

Justices of the Peace, three to be appointed at General Quarter 
Sessions, to visit Licensed Asylums in provinces, three times a 
year, 2 ; frequently neglect to make regulations directed by 
9 Geo. IV. c. 40, 25 ; for Middlesex, do not adjudicate Paupers as 
County Patients without investigation, 28; power or duty of, of 
visiting Licensed Asylums in Borough-towns, now exercised by 
Magistrates of those Boroughs, 67; statement of facts relating to 
visits by, 68 ; seldom consider all the points to which Commis* 
sioners direct their inquiries, 69 ; visits of, not sufficient to put 
down abuses, 70 ; have charge not only of County Asylums but 
all Pauper Lunatics, 85 ; Visiting Justices to examine Orders 
and Certificates, 164 ; mode of exercising their power of libera- 
tion, 171. 

Kent JAsylum, a County Asylum established under 48 Geo. III. 
c. 96, and 9 Geo. IV. c. 40, 9 ; well conducted, 15 ; detached 
Infirmaries at, ib. note; well ventilated, 17; mode of warming 

■ and ventilating, 19 ; use of galleries as day rooms, 22 ; yards at, 
23 ; extent of accommodation at, ib. ; enlarged, 84 ; number of 
Idiots in, 97 ; occupation of Patients at, 131 ; practice as to re 
straint at, 144. 

Kingsdown House, at Box, near Bath, bad condition of, 59 ; steps 
taken by Commissioners for amendment of, 67 ; deficient accom- 
modation for exercise at, 135 ; excessive restraint practised at, 
139. 

Kingsland,*near Shrewsbury, House of Industry at, included in class 
of Licensed Asylums, 10. 

Labour of Patients ought not to be reckoned on as a source of profit, 
129. 

Lainston, Hants, Asylum at, formerly a private mansion, 42 ; bad 
state of, 57 ; steps taken by Commissioners for amendment 
of, 66 ; excessive restraint practised at, 139. 

Lancashire, burdened with unusual number of Paupers whose settle - 

ments are not ascertained, 91. 
Lancaster Asylum, a County Asylum established under 48 Geo, III. c. 
96, and 9 Geo. IV. c. 40, 9 ; inconveniently situated, 15 ; detached 
infirmaries at, ib. note ; want of water at, 16 ; number of Patients 
in, ib. ; arrangement of sleeping cells in, 21 ; yards at, 23 ; enlarge- 
ment of, [25, 84 ; crowded state of, 83, 90 ; accumulation of 
Incurable Patients at, 93 ; suicidal Patients in, 61 ; associated 
with the cheerful, 125; cases of suicide there, it. note; classifica- 



283 

tion at, 126 ; waut of employment for Patients at, 135; non- 
restraint system practised at, 140 ; means adopted for cure of 
dirty habits at, 148 ; religious observances at, 162. 

Laverstock, improvements in Asylum at, 45. 

Leicester Asylum, united County and Subscription Asylum established 
under 48 Geo. III.c. 96, and 9 Geo. IV. c. 40, 9, 30 ; number of 
Patients at, 16 ; disadvantages of its situation, ib, ; mode of 
warming and ventilating, 18 ; yards at, 23 ; expense of, for Pau- 
pers, 31 ; enlargement of, 84 ; deficient accommodation for 
exercise at, 133; religious observances at, 162; irregularity in 
admission of Patients into, 165. 

Leicester, Workhouse at, not licensed, but receives Lunatics, 10^ 97. 

Liberation of Patients, 168 ; plan of gradual, suggested, 169 ; Commis- 
sioners not empowered to grant partial liberty, ib. ; difficulties 
attending, 170; Patients should be examined by competent 
persons previous to, 171 ; irregularities practised in respect of, 
171 — 173; power of, should be vested in some persons under 
sanction of the legislature, 176. 

Licensed Asylums, regulated by 2 & 3 Will. IV. c. 107, and 5 & 6 
Vic. c. 87, 2 ; number of, 3 ; parts of Workhouses included in 
this class, 10 ; use of dormitories in, 13 ; two only built fire- 
proof, 14 ; appointment and dismissal of servants in Provincial 
Asylums vested in visiting Magistrates, 25 ; irregularities in, 25 
et seq. and 35 et seq. ; resident Medical Attendants at, 
28, 113; various descriptions of, 34; general remarks on, 
ib. et seq. ; nervous Patients ought not to be received in, 37 ; 
general remarks on those receiving Paupers, 41 et seq. ; 
alterations required in houses formerly private mansions, 41 et 
seq, ; tenure of, frequently stands in the way of improvement, 
45 ; improvements in several, ib. ; improper practices in, ib. ; 
abuses and defects, 46 et seq. ; escapes from, 72 et seq. ; Medical 
treatment in, 115; allowance of food to Patients in, 118; 
smaller, often cold and damp, 120 ; practice in, as to restraint and 
non-restraint, 145 — 154 ; religious observances at, 160, 161 ; 
order and certificates required for admission of Patients into, 
163, 164 ; different for Private and Pauper Patients, 165 ; pro- 
prietors of, often receive private patients in lodgings irregularly, 
167 ; returns required from proprietors of, 180 ; number of Welsh 
Pauper Lunatics in English Asylums, 200. 
Licenses, additional caution in granting, advisable, 70 ; in Metropolitan 

distiict granted by Commissioners, ib. 
Lincoln Asylum, included in class of Public Hospitals, 10; use of 
dormitories in, 12; mode of warming and ventilating, 21 ; sum 
received at, for Private Patients, in 1843, 32 ; number and cost 
of Pauper Patients in 1843, ib.\ site of, 33; prohibition of 
admission of heated air to the galleries at, 120; use of opiates 
interdicted at, 121 ; non-restraint system practised at, 140 ; 
religious observances at, 163. 



284 

Liverpool Asylum, ineluded in class of Public Hospitals, 10 ; restraint 
at, 144. 

Loddon, Norfolk, bad condition of licensed House at, 40 ; somewhat 
improved on Commissioners, last visit, ib. note. 

Lord Chancellor of England, power given to, by 5 & 6 Vic. c. 87, 2- 

Lord Chancellor of Ireland, his opinion as to custody of Criminal 
Lunatics, 198. 

Lunacy, disease of, essentially different from other maladies, 92 ; sug- 
gestions for amendment of law concerning, 204 et seq. 

Lunatic Asylums, Commissioners authorised to inspect, throughout 
England and Wales, 1 ; statutory provisions respecting, 2 ; num- 
ber of, 3 ; various degrees of merit and defect in, 6 ; different 
classes of, 9 ; Corporate and Borough towns not authorised to 
unite with Counties in erection of, 11, note ; for Paupers, question 
•whether they should be made fire-proof, 14 ; proper site for, 
14, 15 ; importance of warmth, ventilation, and dryness at, 16; 
state of ventilation at, various, 17 ; should have cheerful and 
spacious day-rooms, 22 ; diminution of restraint in, 24 et seq ; 
difficulty of finding good attendants in, 25 ; difficulty of main- 
taining order in large, ib. ; Mania and Dementia prevail- 
ing forms of Insanity in, 105; medical treatment in, 113 
et seq. ; occupation, amusements, and exercise of Patients in, 
128 et seq. ; deficiency in respect to employment in many, 132 ; 
practice regarding Restraint in, 137 et seq. ; safety of attendants 
in, should be secured, 150 ; religious observances at, 159 — 163 ; 
instances of sane persons being sent to, very rare, 176; confine- 
ment in, frequently too much prolonged, ib. ; power of liberation 
from, should be vested in some persons under sanction of the legis- 
lature, 176 ; suggestions as to keeping registers and medical books 
in, 179 ; Criminal Lunatics in, 195 et seq. ; in Wales, 200, and 
note ; number of Welsh Pauper Lunatics in English, ib. 

Lunatics, number of, in England and Wales, 7 ; more than two-thirds 
maintained at the public expense, ib. ; dirty, importance of free 
Ventilation to, 17 ; proper objects of inquiry concerning, 69 ; 
position of such as have not been subjects of Commission, with 
respect to their property whilst confined in Asylums, 76 et seq. ; 
proportion of cures when admitted into Asylums within three 
months of attack, 80 ; great importance of removing to Asy* 
lums as soon as possible, 81, 93 ; curable, generally recover 
withiu first year, 93 ; causes of increase in number of incurable, 
100 ; medical treatment of, 113 et seq. ; suffer from cold, 120 ; 
classification of, 121 ; occupations, amusements, and exercise of, 
128 etseq. ; labour ofj ought not to be reckoned on as a source of 
profit, 129 ; admission and libeftstion of, 163 ; different certifi- 
cates required for Private and Pauper, 165, 166 J law as 
respects order and certificates, on admission of, disregarded and 
evaded, 167 ; liberation of, 168 ; should be examined previous to 
liberation, 171; power of liberating should be vested in some 



285 

persons under sanction of the legislature, 176 ; erroneous opinions 
as to numbers of, 177 ; statistical tables of numbers and con- 
dition of, 184, 185 ; proportion of curable Patients, 187 ; table 
of cures and deaths of, 189 ; total number in England and 
Wales, 190—194. 
Lunatic Poor, especial inquiries concerning, 6 ; Asylums for reception 
of, filled with incurable Patients, ib. ; large number received in 
unlicensed Workhouses, 10 ; importance of out-door occupation 
for, 16, 128 ; general rules for relief of when discharged, desir- 
able, 26, 28 ; practice on discharge of, at Bethnal Green, 27 ; 
number discharged from Lancaster and Middlesex Asylums, ib. ; 
funds for relief of, when discharged, ib. ; construction and cost of 
Asylums for, a matter of national interest, 30 ; comparative ad- 
vantages afforded to, by County Asylums, and Asylums partly 
supported by contributions, 30 ; charges for, in Public Hospitals, 
32; Licensed Houses receiving, 34; Licensed Houses particu- 
larly devoted to reception of, 41 ; treatment of, in Licensed 
Houses, formerly private mansions, ib. et seq. ; proper objects of 
inquiry concerning, 69 ; should not be sent to Asylums at a great 
distance, 75 ; visits of friends to, ib. ; usually detained in Work- 
houses or elsewhere long after first attack of mental disease, 80 ; 
causes of detention of, from Asylums, 81 ; want of accommo- 
dation for, 82 et seq. ; returns of to be made to Quarter Ses- 
sions, 85 ; no means taken for early admission of, into Asylums, 
86 ; number of in Middlesex for whom there is no room in 
County Asylum, 87, 89; number admitted to Marylebone 
Workhouse, 87 ; illegality of detaining recent cases in Work- 
houses, 88 ; number unprovided for in Lancashire, 90 ; in Surrey, 
91 ; whose settlements have not been ascertained, ib. ; erection 
of places of refuge for incurable, recommended, 92; admission of 
into Asylums, 93 ; cost of in Hanwell, 94 ; in Workhouses, 98 
et seq. ; excess of suicidal cases among, 107, note; causes of 
insanity of, 115 ; medical treatment of, 115—117 ; diet of, 118; 
insufficient means of exercise afforded to, in Workhouses, 136; 
certificate required on admission of, into County and Licensed 
Asylums, 166 ; law respecting wholly disregarded, 167 ; subject 
to unjustifiable restraint, ib. ; returns of, 178, 181 ; maintained 
at charge of County, not included in returns, 131 ; proportion per 
cent of, to population, 193 ; neglected state of in Wales, 199 et 
seq. 

Manchester Hospital, included in class of Public Hospitals, 10 ; site 
of, 33. 

Manchester, Workhouse at, not licensed, but receives Lunatics, 10. 

Mania, defined, 103 ; acute, ib. ; chronic, 104 ; intermittent, ib. ; 
recurrent, 105. 

Market-Lavingtou Asylum, use of dormitories in, 13 ; well-conducted 
Licensed House, receiving Paupers, 41. 

Marylebone Workhouse, number of Pauper Lunatics in, 87. 



286 

Medical Attendants, to be appointed at General Quarter Sessions to 
visit Licensed Asylums in provinces three times a year, 2 ; 
general high character of, 8 ; at Hanwell, their onerous duties, 
24 ; at Licensed Asylums, 28, 113 ; in Coiinty Asylums, ib.; 
at St. Peter's Hospital, Bristol, 53 ; generally visit pauper patients 
regularly, 74; opinions of, as to treatment of Insanity, 115 — 
117; as to restraint, 153, 156 — 159; as to tranquillising effect 
of religious services, 160. 

Medical Journal, neglect in lieeping, 40. 

Medical treatment of Patients in Lunatic Asylums, 113; difference 
prevailing as to, in different classes of Asylums, ib. ; opinions of 
Medical Attendants in Asylums respecting, 116, 117; regulations 
of, in some Asylums at variance with general opinion, 118 ; not 
substituted for coercion, 121. 

Melancholia, defined, 106. 

Metropolitan Commissioners in Lunacy, authorised to inspect public 
and private Asylums throughout England and Wales, 1 ; to visit 
Licensed Asylums in Metropolitan district four times a year, 2 ; 
to visit and report on Licensed Asylums in the Provinces twice a 
year, ib. ; and County and other Asylums under 9 Geo. IV. 
c. 40, once a year, ib. ; directed by Lord Chancellor to visit Royal 
Naval and ^lilitary Hospitals, and all other public Asylums except 
Bethlem, ib. ; divide England and Wales into four districts, 4; 
each again subdivided into two parts, ib. ; inquiries instituted by 
them ib. et seq. ; especially as regards Lunatic poor, 6 ; 

, recommendation of, as to Medical Officers, 28 ; exposure 
of main evils chief object in present Report of, 34 ; former!)' 
prosecuted a person for improperly receiving Insane persons as 
boarders, 38 ; their reasons for continuing licenses to the Asylums 
at Peckham and Hoxton, 44 ; proceedings of, with respect to 
Asylum at Haverfordwest, 50 et seq. ; endeavours used by them 
to correct abuses, 65 et seq. ; visits of, to Workhouses, 98 ; extract 
from Report of, on Norfolk Asylum, 114; not empowered to 
grant partial liberty to Patients, 169 ; inquiries of, as to Statistics 
of Insanity extended to Scotland and Ireland, 178. 

Middlesex Asylum. — See Hanwell. 

Middlesex, County of, burdened with unusual number of paupers whose 
settlements are not ascertained, 91. 

Middleton, Lady, fund instituted by, for relief of Pauper Patients dis- 
charged from Nottingham Asylum, 27. 

Military and Naval Hospitals, Commissioners authorised to visit, 2 ; 
number of, 3 ; supported by and under control of Government, 
10 ; at Fort Clarence, 31 ; at Haslar, ib. 

Monomania, defined, 106. 

Moral Insanity, defined, 106. 

Morda, near Oswestry, House of Industry at, included in class of 
Licensed Asylums, 10 ; ill-suited for reception of Patients, 143. 

Morecroft House, case of beneficial restraint at, 149. 



287 

Music, use of in Asylums, 130. 

Nervous Patients, ought not to be received in LicensedHouses, 37 ; their 
admission into such houses without certificates contrary to law, 38. 

Newcastle Asylum, a well-conducted Licensed House receiving Pau- 
pers, 41 ; case of dangerous Lunatic at, 174. 

Norfolk Asylum, a County Asylum established under 48 Geo. III. 
c. 96, and 9 Geo. IV. c. 40, 9 ; number of Patients at, 16 ; dis- 
advantages of its situation, ib. ; yards at, 23 ; possesses no resi- 
dent Medical Officer, 28 ; want of medical attendance at, 114 ; 
deficient accommodations for exercise at, 134. 

Northampton Asylum, included in class of Public Hospitals, 10; not 
fire-proof, 14 ; sum received at, for Private Patients, in 1-342, 
32 ; number and cost of Pauper Patients in, 1843, ib. ; site of, 
33; suicidal propensity in Patients at, 107 ; prevails in Pau- 
per part of establishment, ib., note ; non-restraint system prac- 
tised at, 140 ; religious observances at, 163 ; irregularity in admis- 
sion of Patients, 165. 

Northumberland House, accidents at, from want of restraint, 149. 

Norwich Asylum, see Bethel Hospital. 

Nottingham Asylum, United County and Subscription Asylum, esta- 
blished under 48 Geo. III. c. 96, & 9 Geo. IV. c. 40, 9, 30 ; badly 
situated, 15 ; mode of warming, 18 ; basement stories used for 
Patients, 22 ; unfit for Invalids, ib. ; yards at, 23 ; fund for 
relief of Pauper Patients discharged from, 27 ; County Asylum 
partly supported by contributions, 30 ; expense of, for Paupers, 
41 ; enlarged, 84 ; substitution of recent for old cases at, 93 ; 
want of employment for Patients at, 134 ; restraint at, 144. 

Non-restraint, system of, 140 et seq. 

Nunkeeling, Asylum at, bad state of, 64 ; escape from, 73, 197 ; 
excessive restraint practised at, 139 ; religious observances ut, 
161 ; irregular liberation of Patients from, by Justices, 172. 

Nursling, Hants, Asylum at, formerly a private mansion, 42 ; insuf- 
ficient accommodation for Paupers at, 58 ; steps taken by Coni- 
sioners for amendment of, 66. 

Occupation, amusements, and exercise of Lunatics, 16, 128 et seq. 

Ogilvie, Mr., irregularities practised in his House, Calne, Wilts, 37 ; 
persisted in notwithstanding Commissioners remonstrances, 38. 

Opiates, use of in Lunatic Asylums, 120. 

Order and Certificates required for admission of Patients, not Paupers, 
into Licensed Houses, 163 ; not required by statute in Public 
Hospitals, 164 ; required by private regulations, ib. ; desirable 
in all cases, 165 ; different for Private and Pauper Patients, ib. ; 
disregard and evasion of the law respecting, 167 ; object of 
law in requiring, ib. 

Oulton, neglect of magistrates in visiting, 68. 

Out-door occupation, importance of to Insane Poor, 16, 129. 

Paralysis of the Insane described, 109. 

Pauper Asylum, Cork, 178. 

Pauper Lunatics, see Lunatic Poor. 



288 

Peckham, Asylum at, 43 ; diet at, insufficient, 44. 

Phillips, Mr., restraint at his Asylum near Devizes, 151. 

Philp, Dr., accident at his house from -want of restraint, 151, 

Plympton, Asylum at, formerly a private mansion, 42 ; disgraceful 
condition of, 60 — 63 ; complaints of Visiting Justices disre- 
garded, 60 ; Commissioners' former Report on, quoted, 62 ; steps 
taken for its amendment, 65 ; escape from, 73, 197 ; excessive 
restraint practised at, 139. 

Poor Law Commissioners — their regulations regarding detention of 
Lunatics in Workhouses, 95 ; returns by, of number of Pauper 
Idiots, 96. 

Private Patients in Licensed Houses frequently sleep in dormitories 
containing several beds, 13; in reduced circumstances derive 
benefit, at a moderate cost, from Public Hospitals, 32 ; visits of 
friends to, 75 ; often received in lodgings irregularly, 167 ; re- 
turns of, required, 182. 

Property of Lunatics, not subjects of Commissions, cases respecting, 
76 et seq., 78, note ; suggestions for protection of, 78. 

Public Hospitals, supported wholly or in part by voluntary contri- 
butions, enumerated, 10 ; at Northampton and elsewhere not 
fire-proof, 14 ; appointment of Resident Medical Officers at, re- 
commended, 28 ; Patients in, pay the greater part, and sometimes 
the whole of the expenses of their maintenance and medical atten- 
dance, 32 ; exceptions, ib.; sums received by from Private Patients, 
ib. ; claim of some governing bodies to exemption from visitation, 
33 ; practice as to restraint in, 143 ; religious observances at, 161 

J — 163 ; Orders and Certificates not required by statute for 
admission of Patients into, 164 ; not subject to visitation, ib.\ 
private regulations require Certificates, ib. ; irregularities in 
admission of Patients into, 165 ; Reports of, 178. 

Radcliffe Asylum, now called the Warnefurd Asylum, 10. 
Redruth, Workhouse at, not licensed, but receives Lunatics, 10, 98, 

Refuge near Hull, provisions for exercise at, deficient, 135 ; case of 

irregular removals from by Parish Officers, 173. 
Religious Services and Instruction, proper attention to, generally paid, 

459 ; tranquillising effect of, ib. 
Restraint, diminution and disuse of, in Asylums, 24 ; difficulty of 
maintaining order in large establishments, in absence of, 25 ; 
unnecessary practised at Kingsland, near Shrewsbury, 43 ; prac- 
tice of, at Haverfordwest, 48 ; at Bristol, 53 ; at West Auckland, 
54 ; at Wreckenton, 55; at Lainston, 58; at Kingsdown, near 
Bath, harsh and cruel, 59; at Plympton, 60— 63 ; at Nun- 
keeling, 73; at Licensed House in Yorkshire, 73 ; not a proper 
remedy against escape, except in very violent or dangerous eases, 
74 J various practices in respect to, 137 ; relative advantages of 
restraint and non-restraint, 138 ; not permitted in well-managed 
Asylums, except in extreme cases, 139 ; practice as to, in Public 
Hospitals aud County Asyhmis, 143 ; Licensed Houses, 145 — 



289 

154 ; opinions of Medical Superintendents as to, 152 ; arguments 
for and against the disuse of, 156; cases of unjustifiable, 167. 

Retreat at York, included in class of Public Hospitals, 10 ; sum re- 
ceived at, for Private Patients, in 1842, 32 ; internal accommo- 
dations, &c. 33 ; system of managing Insane at, 138 ; restraint 
at, 143. 

Ringmer, near Lewes, Sussex, defect in management of Asylum at, 39. 

St. Asaph, Dean of, his letter on the state of Pauper Lunatics in 
Wales, 201. 

St. Austle, Workhouse at, woman in raving mania found in, 83. 

St. Luke's Hospital, included in class of Public Hospitals, 10 ; galle- 
ries in, not warmed, 20 ; ventilation imperfect, ib. ; assistance 
given to poor Patients on discharge from, 27 ; sum received at, 
for Private Patients, in 1842, 32 ; site of, 33 ; regulations of, ib. ; 
average of cures at, in 1842 and 1843, 81 ; restraint at, 144 ; 
former neglect of religious observances at, 163; practice as to 
admission of patients into, 166. 

Sandfield, Asylum at, escape from, 73. 

Sheffield, Workhouse at, not licensed, but receives Lunatics, 10. 

Solitary confinement, a register of its application should be kept, 146 ; 
no protection against dirty habits, 147. 

Stafford Asylum, united County and Subscription Asylum established 
under 48 Geo. III. c. 96, and 9 Geo. IV. c. 40, 9, 30 ; use of 
dormitories in, 12 ; arrangements at, much approved, 15, note ; 
expense of, for Paupers, 31 ; in a crowded state, 83 ; religious 
observances at, 162. 

Statistics of Insanity, 177 et seq. 

Statutes referred to : 

39 & 40 Geo. III. c. 94 ; 195, 196. 
48 Geo. HI. c 96 ; 9, 10, 11, 30. 

9 Geo. IV. c. 40; 1, 2, 9, 10,11 and note, 25, 30,72, 85, 
164, 179 and note, 181, 187 and note. 

2 & 3 Will. IV. c. 107 ; 2, 28, 40, 67, 114, 128, 164, 166, 

169, 179 note, 180, 182. 

3 & 4 Will. IV. c. 64, ss. 3, 4 ; 180. 
3 & 4 Vic. c. 54 ; 195, 196. 

5 & 6 Vic. c. 57 ; 181. 

5 86 6 Vic. c. 84 ; 79. 

5 & 6 Vic. c. 87 ; 1, 2, 79,97, 121, 128, 169, 179, note, 180. 
Stoke Damerell, ill suited for reception of patients, but well managed, 

43. 
Subscription Asylums, see Counly Asylums united, ^c. and Public 

Hospitals. 
Suffolk Asylum, a County Asylum established under 48 Geo. III. c. 

96, and 9 Geo. IV. c. 40, 9 ; basement stories of, used for Patients, 

22; in a crowded state, 83 ; non-restraint system practised at, 

140, 142 ; religious observances at, 163. 



290 

Suggestions for the amendment of the law relating to Lunacy, 204 et 
ieq. 

Suicide, propensity of melancholy Patients to, 107 ; statistical state- 
ment of Patients inclined to, at Northampton and Lancaster, iJ.; 
propensity to prevails chiefly in Pauper part of establishment at 
Northampton, ib. note ; classification of Patients inclined to, 124 ; 
cases of at Lancaster, 125, note. 

Surrey Asylum, a County Asylum established under 48 Geo. III. c. 96, 
and 9 Geo. IV. c. 40, 9 ; great expense in making fire-proof, 14, 
note; merits of, 15; well- ventilated, 17; the last erected, 20 ; 
mode of warming and ventilation, ib. ; galleries in, 21 ; basement 
stories used for Patients, 22, 84 ; means used to render them 
cheerful, 22 ; extent of accommodation at, 23. 

Swift's Hospital, Dublin, 178. 

Taylor, Mr., case of beneficial restraint at his Asylum near Bri8tol,149. 

Tuke, Mr., his opinion as to the necessity of a vigorous supervision of 
all Asylums, 71, note. 

Ventilation, importance of, in Lunatic Asylums, 16 ; state of in 
various Asylums, 17 ; results of inquiries respecting, 18 e< seq. 

Visiting Commissioners, returns by, 180. 

Visiting Magistrates, in Middlesex, system pursued by, 88 — 90. 

Visits of friends to Lunatics often interdicted by parties authorising 
their detention, 76. 

Wakefield Asylum, yards at, 23 ; fund for relief of Pauper Pa- 
tients discharged from, 27 ; occupation of Patients at, 131 ; 
restraint at, 144. 

Wales, neglected state of the Insane in, 199 ; number of Pauper 
Lunatics in, 200; state of Pauper Lunatics described in letter by 
the Dean of St. Asaph, 201 ; in letter from Medical Practitioner 
at Denbigh, ib. note ; cases at Carnarvon, 202. 

Wnrmth, importance of in Lunatic Asylums, 16, 119 ; of galleries and 
dormitories, 17 ; results of inquiries respecting, 18 ef seq. 

Warneford Asylum, included in Class of Public Hospitals, 10; sum 
received at, for Private Patients in 1842, 32 ; site of, 33 ; 
restraint at, 144 ; religious observances at, 163. 

West Auckland, Asylum at, bad state of, 53 ; recorded opinion of 
Visiting Magistrates regarding, 54; totally unfit for a Lunatic 
Asylum, 55 ; steps taken by Commissioners for amendment of, 
66 ; want of employment for Patients at, 133 ; excessive re- 
straint practised at, 139. 

West Mailing, concealed sleeping places discovered at, 64. 

Whitmore House, case of necessary restraint at, 147. 

Workhouses, those of which parts are licensed, enumerated, 10 ; many 
not licensed receive large numbers of Insane Persons, ib.', con- 
nection of with Licensed Asylums, 42 ; Poor Law Commissioners* 
direction regarding detention of Lunatics in, 95 ; detention of 
Lunatics in, 98 — 101 ; deficient accommodation for exercise of 
Insane Patients in, 136. 



291 

Wreckentou, bad state of, 55 ; unfit for an Asylum, 56 ; stops 
taken by CommissionerB for amendment, 66; excessive restraint 
practised at, 139. 

Yards of Asylums, proper construction of, 23. 

York Asylum, included in class of Public Hospitals, 10 ; not fire- 
proof, 14 ; fire at, 14, note ; restraint at, 144. 

Yorkshire, Asylum for West Riding of, a County Asylum established 
under 48 Geo. III. c. 96, and 9 Geo. IV. c. 40, 9 ; among the 
best, 15 ; extent of accommodation at, 23 ; in a crowded state, 
83 ; enlarged, 84; substitution of recent for old cases in, 93. 



THE END, 



LONDON : 
BRADBURY AND EVANS, PRINTERS, WHITEPRFARS. 



Deposited by the BOSTON ATHEN^UM 

IN THE LIBRARY OF THE 

25o^ton Sl^cliical %matp ^^-^ociation, 

BY AUTHORITY OF THE TRUSTEES. 

^2rrr..,.e^,_ 



lihrarian. 







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COUNTWAY LIBRARY OF MEDICINE 



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